Input controls for robotic surgery

ABSTRACT

An input control device is disclosed. The input control device includes a central portion coupled to a multi-axis force and torque sensor, which is configured to receive input control motions from a surgeon. The central portion is flexibly supported on a base. The input control device also includes a rotary joint coupled to a rotary sensor. The input control device is configured to provide control motions to a robotic arm and/or a robotic tool based on input controls detected by the multi-axis force and torque sensor and the rotary sensor.

BACKGROUND

Surgical systems often incorporate an imaging system, which can allowthe clinician(s) to view the surgical site and/or one or more portionsthereof on one or more displays such as a monitor. The display(s) can belocal and/or remote to a surgical theater. An imaging system can includea scope with a camera that views the surgical site and transmits theview to a display that is viewable by a clinician. Imaging systems canbe limited by the information that they are able to recognize and/orconvey to the clinician(s). For example, certain concealed structures,physical contours, and/or dimensions within a three-dimensional spacemay be unrecognizable intraoperatively by certain imaging systems.Additionally, certain imaging systems may be incapable of communicatingand/or conveying certain information to the clinician(s)intraoperatively.

Robotic systems can be actuated or remotely-controlled by one or moreclinicians positioned at control consoles. Input motions at the controlconsole(s) can correspond to actuations of a robotic arm and/or arobotic tool coupled thereto. In various instances, the robotic systemand/or the clinician(s) can rely on views and/or information provided byan imaging system to determine the desired robotic actuations and/or thecorresponding suitable input motions. The inability of certain imagingsystems to provide certain visualization data and/or information maypresent challenges and/or limits to the decision-making process of theclinician and/or the controls for the robotic system.

SUMMARY

In various aspects, a control system for a surgical robot is disclosed,the control system including a base, a central portion flexiblysupported by the base, a wrist longitudinally offset from the centralportion and rotationally coupled to the central portion, a multi-axissensor arrangement configured to detect user input forces applied to thecentral portion, a rotary sensor configured to detect user input motionsapplied to the wrist, a memory, and a processor communicatively coupledto the memory. The processor is configured to receive a plurality offirst input signals from the multi-axis sensor arrangement, provide aplurality of first output signals to the surgical robot based on theplurality of first input signals, receive a plurality of second inputsignals from the rotary sensor, and provide a plurality of second outputsignals to the surgical robot based on the plurality of second inputsignals.

In various aspects, a control system for a surgical robot is disclosed,the control system including a first control input including aflexibly-supported joystick, a memory, and a control circuitcommunicatively coupled to the memory. The memory stores instructionsexecutable by the control circuit to switch the control system between afirst mode and a second mode, receive a plurality of first input signalsfrom the first control input, scale the plurality of first input signalsby a first multiplier in the first mode, and scale the plurality offirst input signals by a second multiplier in the second mode. Thesecond multiplier is different than the first multiplier.

In various aspects, a control system for a surgical robot is disclosed,the control system including a first input including aflexibly-supported joystick and a multi-axis force and torque sensorarrangement configured to detect user input forces and torques appliedto the flexibly-supported joystick, a second input including a rotaryjoint and a rotary sensor configured to detect user input motionsapplied to the rotary joint, and a control unit. The control unit isconfigured to provide a first plurality of output signals to thesurgical robot based on actuation of the first input and provide asecond plurality of output signals to the surgical robot based onactuation of the second input.

FIGURES

The novel features of the various aspects are set forth withparticularity in the appended claims. The described aspects, however,both as to organization and methods of operation, may be best understoodby reference to the following description, taken in conjunction with theaccompanying drawings in which:

FIG. 1 is a plan view of a robotic surgical system being used to performa surgery, according to at least one aspect of the present disclosure.

FIG. 2 is a perspective view of a surgeon's control console of therobotic surgical system of FIG. 1 , according to at least one aspect ofthe present disclosure.

FIG. 3 is a diagram of a robotic surgical system, according to at leastone aspect of the present disclosure.

FIG. 4 is a perspective view of a surgeon's control console of a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 5 is a perspective view of a user input device at a surgeon'scontrol console, according to at least one aspect of the presentdisclosure.

FIG. 6 is a perspective view of a user input device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 7 is a plan view of the user input device of FIG. 6 , according toat least one aspect of the present disclosure.

FIG. 8 is a rear elevation view of the user input device of FIG. 6 ,according to at least one aspect of the present disclosure.

FIG. 9 is a side elevation view of the user input device of FIG. 6 ,according to at least one aspect of the present disclosure.

FIG. 10 is a perspective view of a user's hand engaged with the userinput device of FIG. 6 , according to at least one aspect of the presentdisclosure.

FIG. 11 is a rear elevation view of a user's hand engaged with the userinput device of FIG. 6 , according to at least one aspect of the presentdisclosure.

FIG. 11A is a control logic flowchart for the user input device of FIG.6 , according to at least one aspect of the present disclosure.

FIG. 11B is a table depicting control parameters for operational modesof the user input device of FIG. 6 , according to at least one aspect ofthe present disclosure.

FIG. 11C illustrates a control circuit configured to control aspects ofthe user input device of FIG. 6 , according to at least one aspect ofthe present disclosure.

FIG. 11D illustrates a combinational logic circuit configured to controlaspects of the user input device of FIG. 6 , according to at least oneaspect of the present disclosure.

FIG. 11E illustrates a sequential logic circuit configured to controlaspects of the user input device of FIG. 6 , according to at least oneaspect of the present disclosure.

FIG. 12 is a perspective view of an end effector of a surgical tooloperably controllable by control motions supplied to the user inputdevice of FIG. 6 , according to at least one aspect of the presentdisclosure.

FIG. 12A is a perspective view of the end effector of FIG. 12 ,depicting the end effector in an articulated configuration, according toat least one aspect of the present disclosure.

FIGS. 13A and 13B depict an end effector of a surgical tool and the userinput device of FIG. 6 in corresponding open configurations, whereinFIG. 13A is a plan view of the end effector and FIG. 13B is a plan viewof the user input device, according to at least one aspect of thepresent disclosure.

FIGS. 14A and 14B depict the end effector and the user input device ofFIGS. 13A and 13B in corresponding partially-closed configurations,wherein FIG. 14A is a plan view of the end effector and FIG. 14B is aplan view of the user input device, according to at least one aspect ofthe present disclosure.

FIGS. 15A and 15B depict the end effector and the user input device ofFIGS. 13A and 13B in corresponding closed configurations, wherein FIG.15A is a plan view of the end effector and FIG. 15B is a plan view ofthe user input device, according to at least one aspect of the presentdisclosure.

FIG. 16 is a perspective view of a workspace including two of the userinput devices of FIG. 6 positioned on a surface, according to at leastone aspect of the present disclosure.

FIG. 17 is another perspective view of the workspace of FIG. 16 ,according to at least one aspect of the present disclosure.

FIG. 17A is a detail view of a portion of the workspace of FIG. 17 ,according to at least one aspect of the present disclosure.

FIG. 18 is an exploded perspective view of an input device includingfirst and second board members, a light shield, a stop arrangement, anda cap, according to at least one aspect of the present disclosure.

FIG. 19 is an exploded top perspective view of the first and secondboard members and the light shield of FIG. 18 , according to at leastone aspect of the present disclosure.

FIG. 20 is an exploded bottom perspective view of the first and secondboard members and the light shield of FIG. 19 , according to at leastone aspect of the present disclosure.

FIG. 21 is a plan view of pin members of the stop arrangement of FIG. 18positioned in openings in the second board member of FIG. 18 in arotated configuration, according to at least one aspect of the presentdisclosure.

FIG. 22 is cross-sectional elevation view of the first and second boardmembers, the light shield, the stop arrangement, and the cap of FIG. 18in a tilted configuration, according to at least one aspect of thepresent disclosure.

FIG. 23 is a cross-sectional elevation view of a user input device,according to at least one aspect of the present disclosure.

FIG. 24 is a schematic of a surgical visualization system including animaging device and a surgical device, the surgical visualization systemconfigured to identify a critical structure below a tissue surface,according to at least one aspect of the present disclosure.

FIG. 25 is a schematic of a control system for a surgical visualizationsystem configured to receive inputs from a user input device, accordingto at least one aspect of the present disclosure.

FIG. 26 illustrates a control circuit configured to control aspects of asurgical visualization system, according to at least one aspect of thepresent disclosure.

FIG. 27 illustrates a combinational logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 28 illustrates a sequential logic circuit configured to controlaspects of a surgical visualization system, according to at least oneaspect of the present disclosure.

FIG. 29 is a schematic depicting triangularization to determine a depthd_(A) of a critical structure below the tissue surface, according to atleast one aspect of the present disclosure.

FIG. 30 is a schematic of a surgical visualization system configured toidentify a critical structure below a tissue surface, wherein thesurgical visualization system includes a pulsed light source fordetermining a depth d_(A) of the critical structure below the tissuesurface, according to at least one aspect of the present disclosure.

FIG. 31 is a schematic of a surgical visualization system including athree-dimensional camera, wherein the surgical visualization system isconfigured to identify a critical structure that is embedded withintissue, according to at least one aspect of the present disclosure.

FIGS. 32A and 32B are views of the critical structure taken by thethree-dimensional camera of FIG. 31 , in which FIG. 32A is a view from aleft-side lens of the three-dimensional camera and FIG. 32B is a viewfrom a right-side lens of the three-dimensional camera, according to atleast one aspect of the present disclosure.

FIG. 33 is a schematic of the surgical visualization system of FIG. 31 ,in which a camera-to-critical structure distance d_(w) from thethree-dimensional camera to the critical structure can be determined,according to at least one aspect of the present disclosure.

FIG. 34 is a schematic of a surgical visualization system utilizing twocameras to determine the position of an embedded critical structure,according to at least one aspect of the present disclosure.

FIG. 35A is a schematic of a surgical visualization system utilizing acamera that is moved axially between a plurality of known positions todetermine a position of an embedded critical structure, according to atleast one aspect of the present disclosure.

FIG. 35B is a schematic of the surgical visualization system of FIG.35A, in which the camera is moved axially and rotationally between aplurality of known positions to determine a position of the embeddedcritical structure, according to at least one aspect of the presentdisclosure.

FIG. 36 is a schematic of a control system for a surgical visualizationsystem, according to at least one aspect of the present disclosure.

FIG. 37 is a schematic of a structured light source for a surgicalvisualization system, according to at least one aspect of the presentdisclosure.

FIGS. 38-40 depict illustrative hyperspectral identifying signatures todifferentiate anatomy from obscurants, wherein FIG. 38 is a graphicalrepresentation of a ureter signature versus obscurants, FIG. 39 is agraphical representation of an artery signature versus obscurants, andFIG. 40 is a graphical representation of a nerve signature versusobscurants, according to at least one aspect of the present disclosure.

FIG. 41 is a schematic of a near infrared (NIR) time-of-flightmeasurement system configured to sense distance to a critical anatomicalstructure, the time-of-flight measurement system including a transmitter(emitter) and a receiver (sensor) positioned on a common device,according to at least one aspect of the present disclosure.

FIG. 42 is a schematic of an emitted wave, a received wave, and a delaybetween the emitted wave and the received wave of the NIR time-of-flightmeasurement system of FIG. 41 , according to at least one aspect of thepresent disclosure.

FIG. 43 illustrates a NIR time-of-flight measurement system configuredto sense a distance to different structures, the time-of-flightmeasurement system including a transmitter (emitter) and a receiver(sensor) on separate devices, according to at least one aspect of thepresent disclosure.

FIG. 44 is a perspective view of an input control device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 45 is another perspective view of the input control device of FIG.44 , according to at least one aspect of the present disclosure.

FIG. 46 is a front elevation view of the input control device of FIG. 44, according to at least one aspect of the present disclosure.

FIG. 47 is a side elevation view of the input control device of FIG. 44in a first configuration illustrated with solid lines and furtherdepicting the input control device in a second configuration illustratedwith dashed lines, wherein a lower portion, or base, of the inputcontrol device remains stationary and an upper portion of the inputcontrol device is displaced along a longitudinal axis between the firstconfiguration and the second configuration, according to at least oneaspect of the present disclosure.

FIG. 48 is a perspective view of a user's hand and forearm engaged withthe input control device of FIG. 44 , according to at least one aspectof the present disclosure.

FIG. 49 is a front elevation view of a user's hand and forearm engagedwith the input control device of FIG. 44 , according to at least oneaspect of the present disclosure.

FIG. 50 is a logic diagram for a control circuit utilized in connectionwith the input control device of FIG. 44 , according to at least oneaspect of the present disclosure.

FIG. 51 is a perspective view of an input control device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 52 is a rear elevation view of the input control device of FIG. 51, according to one aspect of the present disclosure.

FIG. 53 is a perspective view an input control device for a roboticsurgical system, according to at least one aspect of the presentdisclosure.

FIG. 54 is a side elevation view of the input control device of FIG. 53, in a first configuration illustrated with solid lines and furtherdepicting the input control device in a second configuration illustratedwith dashed lines, wherein a lower portion, or base, of the inputcontrol device remains stationary and an upper portion of the inputcontrol device is displaced along a longitudinal axis between the firstconfiguration and the second configuration, according to at least oneaspect of the present disclosure.

FIG. 55 is a perspective view of a user's hand and forearm engaged withthe input control device of FIG. 53 , according to at least one aspectof the present disclosure.

FIG. 56 is a side elevation view of a user's hand and forearm engagedwith the input control device of FIG. 53 , according to at least oneaspect of the present disclosure.

FIG. 57 is a perspective view of an input control device, according toat least one aspect of the present disclosure.

FIG. 58 is another perspective view of the input control device of FIG.57 , according to at least one aspect of the present disclosure.

FIG. 59 is an elevation view of the input control device of FIG. 57 ,according to at least one aspect of the present disclosure.

FIG. 59A is another elevation view of the input control device of FIG.57 with certain features removed for clarity and schematically depictinga control circuit therein, according to at least one aspect of thepresent disclosure.

FIG. 60 is a perspective view of a user's hand engaged with the inputcontrol device of FIG. 57 and positioned to delivery input controlmotions to the various input controllers thereof, according to at leastone aspect of the present disclosure.

FIG. 61 is an elevation view of a user's hand engaged with the inputcontrol device of FIG. 57 and positioned to deliver input controlmotions to the various input controllers thereof, according to at leastone aspect of the present disclosure.

FIG. 62 is a hypothetical graphical representation of input controlsensitivity relative to tissue proximity for the input control device ofFIG. 57 , according to at least one aspect of the present disclosure.

FIG. 63 is a perspective view of an input control device positioned in ahome position within a gross motion zone, according to at least oneaspect of the present disclosure.

FIG. 64 is another perspective view of the input control device of FIG.63 , according to at least one aspect of the present disclosure.

FIG. 65 is a perspective view of a user's hand engaged with the inputcontrol device of FIG. 63 , according to at least one aspect of thepresent disclosure.

FIG. 66 is another perspective view of a user's hand engaged with theinput control device of FIG. 63 , according to at least one aspect ofthe present disclosure.

FIG. 67 is an elevation view of a user's hand engaged with the inputcontrol device of FIG. 63 , according to at least one aspect of thepresent disclosure.

FIG. 68 is a hypothetical graphical representation of robotic tool speedrelative to displacement of the input control device of FIG. 63 withinthe gross motion zone of FIG. 63 , according to at least one aspect ofthe present disclosure.

DESCRIPTION

Applicant of the present application owns the following U.S. patentapplications, filed on Mar. 15, 2019, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/354,420, titled DUAL MODE        CONTROLS FOR ROBOTIC SURGERY, now U.S. Patent Application        Publication No. 2020/0289228;    -   U.S. patent application Ser. No. 16/354,422, titled MOTION        CAPTURE CONTROLS FOR ROBOTIC SURGERY, now U.S. Patent        Application Publication No. 2020/0289216;    -   U.S. patent application Ser. No. 16/354,440, titled ROBOTIC        SURGICAL SYSTEMS WITH MECHANISMS FOR SCALING SURGICAL TOOL        MOTION ACCORDING TO TISSUE PROXIMITY, now U.S. Pat. No.        11,213,361;    -   U.S. patent application Ser. No. 16/354,444, titled ROBOTIC        SURGICAL SYSTEMS WITH MECHANISMS FOR SCALING CAMERA        MAGNIFICATION ACCORDING TO PROXIMITY OF SURGICAL TOOL TO TISSUE,        now U.S. Patent Application Publication No. 2020/0289205;    -   U.S. patent application Ser. No. 16/354,454, titled ROBOTIC        SURGICAL SYSTEMS WITH SELECTIVELY LOCKABLE END EFFECTORS, now        U.S. Pat. No. 11,471,229;    -   U.S. patent application Ser. No. 16/354,461, titled SELECTABLE        VARIABLE RESPONSE OF SHAFT MOTION OF SURGICAL ROBOTIC SYSTEMS,        now U.S. Patent Application Publication No. 2020/0289222;    -   U.S. patent application Ser. No. 16/354,470, titled SEGMENTED        CONTROL INPUTS FOR SURGICAL ROBOTIC SYSTEMS, now U.S. Patent        Application Publication No. 2020/0289223;    -   U.S. patent application Ser. No. 16/354,474, titled ROBOTIC        SURGICAL CONTROLS HAVING FEEDBACK CAPABILITIES, U.S. Pat. No.        11,490,981;    -   U.S. patent application Ser. No. 16/354,478, titled ROBOTIC        SURGICAL CONTROLS WITH FORCE FEEDBACK, U.S. Pat. No. 11,284,297;        and    -   U.S. patent application Ser. No. 16/354,481, titled JAW        COORDINATION OF ROBOTIC SURGICAL CONTROLS, U.S. Pat. No.        11,583,350.

Applicant of the present application also owns the following U.S. patentapplications, filed on Sep. 11, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 16/128,179, titled SURGICAL        VISUALIZATION PLATFORM;    -   U.S. patent application Ser. No. 16/128,180, titled CONTROLLING        AN EMITTER ASSEMBLY PULSE SEQUENCE;    -   U.S. patent application Ser. No. 16/128,198, titled SINGULAR EMR        SOURCE EMITTER ASSEMBLY;    -   U.S. patent application Ser. No. 16/128,207, titled COMBINATION        EMITTER AND CAMERA ASSEMBLY;    -   U.S. patent application Ser. No. 16/128,176, titled SURGICAL        VISUALIZATION WITH PROXIMITY TRACKING FEATURES;    -   U.S. patent application Ser. No. 16/128,187, titled SURGICAL        VISUALIZATION OF MULTIPLE TARGETS;    -   U.S. patent application Ser. No. 16/128,192, titled        VISUALIZATION OF SURGICAL DEVICES;    -   U.S. patent application Ser. No. 16/128,163, titled OPERATIVE        COMMUNICATION OF LIGHT;    -   U.S. patent application Ser. No. 16/128,197, titled ROBOTIC        LIGHT PROJECTION TOOLS;    -   U.S. patent application Ser. No. 16/128,164, titled SURGICAL        VISUALIZATION FEEDBACK SYSTEM;    -   U.S. patent application Ser. No. 16/128,193, titled SURGICAL        VISUALIZATION AND MONITORING;    -   U.S. patent application Ser. No. 16/128,195, titled INTEGRATION        OF IMAGING DATA;    -   U.S. patent application Ser. No. 16/128,170, titled        ROBOTICALLY-ASSISTED SURGICAL SUTURING SYSTEMS;    -   U.S. patent application Ser. No. 16/128,183, titled SAFETY LOGIC        FOR SURGICAL SUTURING SYSTEMS;    -   U.S. patent application Ser. No. 16/128,172, titled ROBOTIC        SYSTEM WITH SEPARATE PHOTOACOUSTIC RECEIVER; and    -   U.S. patent application Ser. No. 16/128,185, titled FORCE SENSOR        THROUGH STRUCTURED LIGHT DEFLECTION.

Applicant of the present application also owns the following U.S. patentapplications, filed on Mar. 29, 2018, each of which is hereinincorporated by reference in its entirety:

-   -   U.S. patent application Ser. No. 15/940,627, titled DRIVE        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,676, titled AUTOMATIC        TOOL ADJUSTMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS;    -   U.S. patent application Ser. No. 15/940,711, titled SENSING        ARRANGEMENTS FOR ROBOT-ASSISTED SURGICAL PLATFORMS; and    -   U.S. patent application Ser. No. 15/940,722, titled        CHARACTERIZATION OF TISSUE IRREGULARITIES THROUGH THE USE OF        MONO-CHROMATIC LIGHT REFRACTIVITY.

Before explaining various aspects of a robotic surgical platform indetail, it should be noted that the illustrative examples are notlimited in application or use to the details of construction andarrangement of parts illustrated in the accompanying drawings anddescription. The illustrative examples may be implemented orincorporated in other aspects, variations, and modifications, and may bepracticed or carried out in various ways. Further, unless otherwiseindicated, the terms and expressions employed herein have been chosenfor the purpose of describing the illustrative examples for theconvenience of the reader and are not for the purpose of limitationthereof. Also, it will be appreciated that one or more of thefollowing-described aspects, expressions of aspects, and/or examples,can be combined with any one or more of the other following-describedaspects, expressions of aspects, and/or examples.

Robotic Systems

An exemplary robotic system 110 is depicted in FIG. 1 . The roboticsystem 110 is a minimally invasive robotic surgical (MIRS) systemtypically used for performing a minimally invasive diagnostic orsurgical procedure on a patient 112 who is lying down on an operatingtable 114. The robotic system 110 includes a surgeon's console 116 foruse by a surgeon 118 during the procedure. One or more assistants 120may also participate in the procedure. The robotic system 110 canfurther include a patient side cart 122, i.e. a surgical robot, and anelectronics cart 124. The surgical robot 122 can manipulate at least oneremovably coupled tool assembly 126 (hereinafter referred to as a“tool”) through a minimally invasive incision in the body of the patient112 while the surgeon 118 views the surgical site through the console116. An image of the surgical site can be obtained by an imaging devicesuch as a stereoscopic endoscope 128, which can be manipulated by thesurgical robot 122 to orient the endoscope 128. Alternative imagingdevices are also contemplated.

The electronics cart 124 can be used to process the images of thesurgical site for subsequent display to the surgeon 118 through thesurgeon's console 116. In certain instances, the electronics of theelectronics cart 124 can be incorporated into another structure in theoperating room, such as the operating table 114, the surgical robot 122,the surgeon's console 116, and/or another control station, for example.The number of robotic tools 126 used at one time will generally dependon the diagnostic or surgical procedure and the space constraints withinthe operating room among other factors. If it is necessary to change oneor more of the robotic tools 126 being used during a procedure, anassistant 120 may remove the robotic tool 126 from the surgical robot122 and replace it with another tool 126 from a tray 130 in theoperating room.

Referring primarily to FIG. 2 , the surgeon's console 116 includes aleft eye display 132 and a right eye display 134 for presenting thesurgeon 118 with a coordinated stereo view of the surgical site thatenables depth perception. The console 116 further includes one or moreinput control devices 136, which in turn cause the surgical robot 122 tomanipulate one or more tools 126. The input control devices 136 canprovide the same degrees of freedom as their associated tools 126 toprovide the surgeon with telepresence, or the perception that the inputcontrol devices 136 are integral with the robotic tools 126 so that thesurgeon has a strong sense of directly controlling the robotic tools126. To this end, position, force, and tactile feedback sensors may beemployed to transmit position, force, and tactile sensations from therobotic tools 126 back to the surgeon's hands through the input controldevices 136. The surgeon's console 116 can be located in the same roomas the patient 112 so that the surgeon 118 may directly monitor theprocedure, be physically present if necessary, and speak to an assistant120 directly rather than over the telephone or other communicationmedium. However, the surgeon 118 can be located in a different room, acompletely different building, or other remote location from the patient112 allowing for remote surgical procedures. A sterile field can bedefined around the surgical site. In various instances, the surgeon 118can be positioned outside the sterile field.

Referring again to FIG. 1 , the electronics cart 124 can be coupled withthe endoscope 128 and can include a processor to process captured imagesfor subsequent display, such as to a surgeon on the surgeon's console116, or on another suitable display located locally and/or remotely. Forexample, when the stereoscopic endoscope 128 is used, the electronicscart 124 can process the captured images to present the surgeon withcoordinated stereo images of the surgical site. Such coordination caninclude alignment between the opposing images and can include adjustingthe stereo working distance of the stereoscopic endoscope. As anotherexample, image processing can include the use of previously-determinedcamera calibration parameters to compensate for imaging errors of theimage capture device, such as optical aberrations, for example. Invarious instances, the robotic system 110 can incorporate a surgicalvisualization system, as further described herein, such that anaugmented view of the surgical site that includes hidden criticalstructures, three-dimensional topography, and/or one or more distancescan be conveyed to the surgeon at the surgeon's console 116.

FIG. 3 diagrammatically illustrates a robotic surgery system 150, suchas the MIRS system 110 (FIG. 1 ). As discussed herein, a surgeon'sconsole 152, such as the surgeon's console 116 (FIGS. 1 and 2 ), can beused by a surgeon to control a surgical robot 154, such as the surgicalrobot 122 (FIG. 1 ), during a minimally invasive procedure. The surgicalrobot 154 can use an imaging device, such as a stereoscopic endoscope,for example, to capture images of the surgical site and output thecaptured images to an electronics cart 156, such as the electronics cart124 (FIG. 1 ). As discussed herein, the electronics cart 156 can processthe captured images in a variety of ways prior to any subsequentdisplay. For example, the electronics cart 156 can overlay the capturedimages with a virtual control interface prior to displaying the combinedimages to the surgeon via the surgeon's console 152. The surgical robot154 can output the captured images for processing outside theelectronics cart 156. For example, the surgical robot 154 can output thecaptured images to a processor 158, which can be used to process thecaptured images. The images can also be processed by a combination ofthe electronics cart 156 and the processor 158, which can be coupledtogether to process the captured images jointly, sequentially, and/orcombinations thereof. One or more separate displays 160 can also becoupled with the processor 158 and/or the electronics cart 156 for localand/or remote display of images, such as images of the surgical site, orother related images.

The reader will appreciate that various robotic tools can be employedwith the surgical robot 122 and exemplary robotic tools are describedherein. Referring again to FIG. 1 , the surgical robot 122 shownprovides for the manipulation of three robotic tools 126 and the imagingdevice 128, such as a stereoscopic endoscope used for the capture ofimages of the site of the procedure, for example. Manipulation isprovided by robotic mechanisms having a number of robotic joints. Theimaging device 128 and the robotic tools 126 can be positioned andmanipulated through incisions in the patient so that a kinematic remotecenter or virtual pivot is maintained at the incision to minimize thesize of the incision. Images of the surgical site can include images ofthe distal ends of the robotic tools 126 when they are positioned withinthe field-of-view (FOV) of the imaging device 128. Each tool 126 isdetachable from and carried by a respective surgical manipulator, whichis located at the distal end of one or more of the robotic joints. Thesurgical manipulator provides a moveable platform for moving theentirety of a tool 126 with respect to the surgical robot 122, viamovement of the robotic joints. The surgical manipulator also providespower to operate the robotic tool 126 using one or more mechanicaland/or electrical interfaces. In various instances, one or more motorscan be housed in the surgical manipulator for generating controlsmotions. One or more transmissions can be employed to selectively couplethe motors to various actuation systems in the robotic tool.

The foregoing robotic systems are further described in U.S. patentapplication Ser. No. 15/940,627, titled DRIVE ARRANGEMENTS FORROBOT-ASSISTED SURGICAL PLATFORMS, filed Mar. 29, 2018, which isincorporated by reference herein in its entirety. Alternative roboticsystems are also contemplated.

Referring now to FIG. 4 , a surgeon's console, or control unit, 250 isshown. The surgeon's console 250 can be used in connection with arobotic system to control any two surgical tools coupled to the roboticsystem. The surgical tools can be controlled by the handle assemblies256 of the surgeon's console 250. For example, the handle assemblies 256and robotic arms have a master-slave relationship so that movement ofthe handle assemblies 256 produces a corresponding movement of thesurgical tools. A controller 254 receives input signals from the handleassemblies 256, computes a corresponding movement of the surgical tools,and provides output signals to move the robotic arms and the surgicaltools.

The handle assemblies 256 are located adjacent to a surgeon's chair 258and coupled to the controller 254. The controller 254 may include one ormore microprocessors, memory devices, drivers, etc. that convert inputinformation from the handle assemblies 256 into output control signalswhich move the robotic arms and/or actuate the surgical tools. Thesurgeon's chair 258 and the handle assemblies 256 may be in front of avideo console 248, which can be linked to an endoscope to provide videoimages of the patient. The surgeon's console 250 may also include ascreen 260 coupled to the controller 254. The screen 260 may displaygraphical user interfaces (GUIs) that allow the surgeon to controlvarious functions and parameters of the robotic system.

Each handle assembly 256 includes a handle/wrist assembly 262. Thehandle/wrist assembly 262 has a handle 264 that is coupled to a wrist266. The wrist 266 is connected to a forearm linkage 268 that slidesalong a slide bar 270. The slide bar 270 is pivotally connected to anelbow joint 272. The elbow joint 272 is pivotally connected to ashoulder joint 274 that is attached to the controller 254. The surgeonsitting at the surgeon's console 250 can provide input control motionsto the handle assemblies 256 to effect movements and/or actuations of asurgical tool communicatively coupled thereto. For example, the surgeoncan advance the forearm linkage 268 along the slide bar 270 to advancethe surgical tool toward a surgical site. Rotations at the wrist 266,elbow joint 272, and/or shoulder joint 274 can effect rotation and/orarticulation of the surgical tool about the corresponding axes. Therobotic system and surgeon's console 250 are further described in U.S.Pat. No. 6,951,535, titled TELE-MEDICINE SYSTEM THAT TRANSMITS AN ENTIRESTATE OF A SUBSYSTEM, which issued Oct. 4, 2005, the entire disclosureof which is incorporated by reference herein.

A handle assembly for use at a surgeon's console is further depicted inFIG. 5 . The handle assembly of FIG. 5 includes a control input wrist352 and a touch sensitive handle 325. The control input wrist 352 is agimbaled device that pivotally supports the touch sensitive handle 325to generate control signals that are used to control a robotic surgicalmanipulator and the robotic surgical tools. A pair of control inputwrists 352 and touch sensitive handles 325 can be supported by a pair ofcontrol input arms in a workspace of the surgeon's console.

The control input wrist 352 includes first, second, and third gimbalmembers 362, 364, and 366, respectively. The third gimbal member 366 canbe rotationally mounted to a control input arm. The touch sensitivehandle 325 include a tubular support structure 351, a first grip 350A,and a second grip 350B. The first grip 350A and the second grip 350B aresupported at one end by the tubular support structure 351. The touchsensitive handle 325 can be rotated about axis G. The grips 350A, 350Bcan be squeezed or pinched together about the tubular support structure351. The “pinching” or grasping degree of freedom in the grips isindicated by arrows Ha and Hb.

The touch sensitive handle 325 is rotatably supported by the firstgimbal member 362 by means of a rotational joint 356 g. The first gimbalmember 362 is in turn, rotatably supported by the second gimbal member364 by means of the rotational joint 356 f. Similarly, the second gimbalmember 364 is rotatably supported by the third gimbal member 366 using arotational joint 356 e. In this manner, the control input wrist 352allows the touch sensitive handle 325 to be moved and oriented in theworkspace using three degrees of freedom.

The movements in the gimbals 362, 364, 366 of the control input wrist352 to reorient the touch sensitive handle 325 in space can betranslated into control signals to control a robotic surgicalmanipulator and the robotic surgical tools. The movements in the grips350A and 350B of the touch sensitive handle 325 can also be translatedinto control signals to control the robotic surgical manipulator and therobotic surgical tools. In particular, the squeezing motion of the grips350A and 350B over their freedom of movement indicated by arrows Ha andHb, may be used to control the end effectors of the robotic surgicaltools.

To sense the movements in the touch sensitive handle 325 and generatecontrols signals, sensors can be mounted in the handle 325 as well asthe first gimbal member 362 of the control input wrist 352. Exemplarysensors may be a pressure sensor, Hall Effect transducer, apotentiometer, and/or an encoder, for example. The robotic surgicalsystems and handle assembly of FIG. 5 are further described in U.S. Pat.No. 8,224,484, titled METHODS OF USER INTERFACE WITH ALTERNATIVE TOOLMODE FOR ROBOTIC SURGICAL TOOLS, which issued Jul. 17, 2012, the entiredisclosure of which is incorporated by reference herein.

Existing robotic systems can incorporate a surgical visualizationsystem, as further described herein. In such instances, additionalinformation regarding the surgical site can be determined and/orconveyed to the clinician(s) in the surgical theater, such as to asurgeon positioned at a surgeon's console. For example, the clinician(s)can observe an augmented view of reality of the surgical site thatincludes additional information such as various contours of the tissuesurface, hidden critical structures, and/or one or more distances withrespect to anatomical structures. In various instances, proximity datacan be leveraged to improve one or more operations of the roboticsurgical system and or controls thereof, as further described herein.

Input Control Devices

Referring again to the robotic system 150 in FIG. 3 , the surgeon'sconsole 152 allows the surgeon to provide manual input commands to thesurgical robot 154 to effect control of the surgical tool and thevarious actuations thereof. Movement of an input control device by asurgeon at the surgeon's console 152 within a predefined working volume,or work envelope, results in a corresponding movement or operation ofthe surgical tool. For example, referring again to FIG. 2 , a surgeoncan engage each input control device 136 with one hand and move theinput control devices 136 within the work envelope to provide controlmotions to the surgical tool. Surgeon's consoles (e.g. the surgeon'sconsole 116 in FIGS. 1 and 2 and the surgeon's console 250 in FIG. 4 )can be expensive and require a large footprint. For example, the workingvolume of the user input device (e.g. the handle/wrist assembly 262 inFIG. 4 and the control input wrist 352 and touch sensitive handle 325 inFIG. 5 ) at the surgeon's consoles can necessitate a large footprint,which impacts the usable space in the operating room (OR), trainingmodalities, and cooperative procedures, for example. For example, such alarge footprint can preclude the option of having multiple controlstations in the OR, such as additional control stations for training oruse by an assistant. Additionally, the size and bulkiness of a surgeon'sconsole can be cumbersome to relocate within an operating room or movebetween operating rooms, for example.

Ergonomics is an important consideration for surgeons who may spend manyhours each day in surgery and/or at the surgeon's console. Excessive,repetitive motions during surgical procedures can lead to fatigue andchronic injury for the surgeon. It can be desirable to maintain acomfortable posture and/or body position while providing inputs to therobotic system. However, in certain instances, the surgeon's postureand/or position may be compromised to ensure proper positioning of asurgical tool. For example, surgeons are often prone to contort theirhands and/or extend their arms for long durations of time. In oneinstance, a gross control motion to move the surgical tool to thesurgical site may result in the surgeon's arms being uncomfortably toooutstretched and/or cramped uncomfortably close upon reaching thesurgical site. In certain instances, poor ergonomic posturing achievedduring the gross control motion may be maintained during a subsequentfine control motion, e.g. when manipulating tissue at the surgical site,which can further exasperate the poor ergonomics for the surgeon.Existing input control devices propose a one-size-fits-all approachregardless of the surgeon's anthropometrics; however, the ergonomicimpact to a surgeon can vary and certain body types may be more burdenedby the architecture of existing input control devices.

In certain instances, an input control device can be restrained withinthe work envelope that defines its range of motion. For example, thestructure of the surgeon's console and/or the linkages on the inputcontrol device can limit the range of the motion of the input controldevice. In certain instances, the input control device can reach the endof its range of motion before the surgical tool is appropriatelypositioned. In such instances, a clutching mechanism can be required toreposition the input control device within the work envelope to completethe positioning of the surgical tool. A hypothetical work envelope 280is shown in FIG. 4 , for example. In various instances, the surgeon canbe required to actuate a clutch (often in the form of a foot pedal oradditional button on the handle of the input control device) totemporarily disengage the input control device from the surgical toolwhile the input control device is relocated to a desired position withinthe work envelope. This non-surgical motion by the surgeon can bereferred to as a “rowing” motion to properly reposition the user inputdevice within the work envelope because of the arm motion of the surgeonat the surgeon's console. Upon release of the clutch, the motions of theinput control device can again control the surgical tool.

Clutching the input control device to maintain a suitable positionwithin the work envelope poses an additional cognitive burden to thesurgeon. In such instances, the surgeon is required to constantlymonitor the position and orientation of his/her hands relative to theboundaries of the work envelope. Additionally, the clutching or “rowing”motion can be tedious to the surgeon and such a monotonous, repetitivemotion does not match the analogous workflow of a surgical procedureoutside the context of robotic surgery. Clutching also requires thesurgeon to match a previous orientation of the handle when reengagingthe system. For example, upon completion of a complex range of motion inwhich the surgeon “rows” or clutches the input control device back to acomfortable, home position, the surgeon and/or surgical robot must matchthe orientation of the handle of the input control device in the homeposition to the previous orientation of the handle in the extendedposition, which can be challenging and/or require complex logic and/ormechanics.

Requiring a clutch mechanism also limits the availability of controls onthe handle of the input control device. For example, a clutch actuatorcan take up valuable real estate on the handle, which cognitively andphysically limits the availability of other controls on the handle. Inturn, the complexity of other subsystems, such as a peddle board, isincreased and the surgeon may be required to utilize multiple inputsystems to complete a simple task.

Non-clutched alternatives to such input control devices can reduce thefootprint and cost of the surgeon's console, improve the surgeon'sergonomic experience, eliminate the physical and cognitive burdensassociated with clutching, and/or provide additional real estate on theinput control device for additional input controls, for example.Exemplary non-clutched input control devices are further describedherein. Such non-clutched input control devices can be employed with avariety of robotic systems. Moreover, as further described herein, thenon-clutched input control devices can leverage information from variousdistance determining subsystems also disclosed herein. For example,real-time structured light and three-dimensional shape modeling caninform the logic of such non-clutched input control devices such that afirst mode and/or first collection of controls are enabled outside apredefined distance from an anatomical surface and/or critical structureand a second mode and/or second collection of controls are enabledwithin a predefined distance of the anatomical structure and/or criticalstructure. Various tissue proximity applications are further describedherein.

Referring now to FIGS. 6-11 , an input control device 1000 is shown. Theinput control device 1000 is a clutchless input control device, asfurther described herein. The input control device 1000 can be utilizedat a surgeon's console or workspace for a robotic surgical system. Forexample, the input control device 1000 can be incorporated into asurgical system, such as the surgical system 110 (FIG. 1 ) or thesurgical system 150 (FIG. 3 ), for example, to provide control signalsto a surgical robot and/or surgical tool coupled thereto. The inputcontrol device 1000 includes input controls for moving the robotic armand/or the surgical tool in three-dimensional space. For example, thesurgical tool controlled by the input control device 1000 can beconfigured to move and/or rotate relative to X, Y, and Z axes.

An exemplary surgical tool 1050 is shown in FIG. 12 . The surgical tool1050 is a grasper that includes an end effector 1052 having opposingjaws 1054, which are configured to releasably grab tissue. The surgicaltool 1050 can be maneuvered in three dimensional space by translatingthe surgical tool 1050 along the X_(t), Y_(t), and Z_(t) axes thereof.The surgical tool 1050 also includes a plurality of joints such that thesurgical tool can be rotated and/or articulated into a desiredconfiguration. The surgical tool 1050 can be configured to rotate orroll about the X_(t) axis defined by the longitudinal shaft of thesurgical tool 1050, rotate or articulate about a first articulation axisparallel to the Y_(t) axis, and rotate or articulate about a secondarticulation axis parallel to the Z_(t) axis. Rolling about the X_(t)axis corresponds to a rolling motion of the end effector 1052 in thedirection R_(t), articulation about the first articulation axiscorresponds to a pitching motion of the end effector 1052 in thedirection Pt, and articulation about the second articulation axiscorresponds to a yawing or twisting motion in the direction T_(t).

An input control device, such as the input control device 1000, forexample, can be configured to control the translation and rotation ofthe end effector 1052. To control such motion, the input control device1000 includes corresponding input controls. For example, the inputcontrol device 1000 includes at least six degrees of freedom of inputcontrols for moving the surgical tool 1050 in three dimensional spacealong the X_(t), Y_(t), and Z_(t) axes, for rolling the end effector1052 about the X_(t) axis, and for articulating the end effector 1052about the first and second articulation axes. Additionally, the inputcontrol device 1000 includes an end effector actuator for actuating theopposing jaws of the end effector 1052 to manipulate or grip tissue.Additional features of the input control device 1000 with respect to asurgical tool, such as the surgical tool 1050, for example, are furtherdescribed herein.

Referring again to FIGS. 6-11 , the input control device 1000 includes amulti-dimensional space joint 1006 having a central portion 1002supported on a base 1004. The base 1004 is structured to rest on asurface, such as a desk or work surface at a surgeon's console/workspaceor at the patient's bedside, for example. The base 1004 defines acircular base with a contoured edge; however, alternative geometries arecontemplated. The base 1004 can remain in a fixed, stationary positionrelative to an underlying surface upon application of the input controlsthereto. In certain instances, the base 1004 can be releasably securedand/or clamped to the underlying surface with fasteners, such asthreaded fasteners, for example. In other instances, fasteners may notbe required to hold the base 1004 to the underlying surface. In variousinstances, the base 1004 can include a sticky or tacking bottom surfaceand/or suction features (e.g. suction cups or magnets) for gripping anunderlying surface. In certain instances, the base 1004 can include aribbed and/or grooved bottom surface for engaging a complementaryunderlying support surface.

The space joint 1006 is configured to receive multi-dimensional manualinputs from a surgeon (e.g. the surgeon's hand or arm) corresponding tocontrol motions for the surgical tool in multi-dimensional space. Thecentral portion 1002 of the space joint 1006 is configured to receiveinput forces in multiple directions, such as forces along and/or aboutthe X, Y, and Z axes. The central portion 1002 can include a raising,lowering, and rotating cylinder, shaft, or hemisphere, for example,projecting from the base 1004. The central portion 1002 is flexiblysupported relative to the base 1004 such that the cylinder, shaft,and/or hemisphere is configured to move or float within a smallpredefined zone upon receipt of force control inputs thereto. Forexample, the central portion 1002 can be a floating shaft that issupported on the base 1004 by one or more elastomeric members such assprings, for example. The central portion 1002 can be configured to moveor float within a predefined three-dimensional volume. For example,elastomeric couplings can permit movement of the central portion 1002relative to the base 1004; however, restraining plates, pins, and/orother structures can be configured to limit the range of motion of thecentral portion 1002 relative to the base 1004. In one aspect, movementof the central portion 1002 from a central or “home” position relativeto the base 1004 can be permitted within a range of about 1.0 mm toabout 5.0 mm in any direction (up, down, left, right, backwards andforwards). In other instances, movement of the central portion 1002relative to the base 1004 can be restrained to less than 1.0 mm or morethan 5.0 mm. In certain instances, the central portion 1002 can moveabout 2.0 mm in all directions relative to the base 1004. In variousinstances, the space joint 1006 can be similar to a multi-dimensionalmouse, or space mouse. An exemplary space mouse is provided by3Dconnexion Inc. and described at www.d3connexion.com, for example.

In various instances, the space joint 1006 includes a multi-axis forceand/or torque sensor arrangement 1048 (see FIGS. 8 and 9 ) configured todetect the input forces and moments applied to the central portion 1002and transferred to the space joint 1006. The sensor arrangement 1048 ispositioned on one or more of the surfaces at the interface between thecentral portion 1002 and the base 1004. In other instances, the sensorarrangement 1048 can be embedded in the central portion 1002 or the base1004. In still other instances, the sensor arrangement 1048 can bepositioned on a floating member positioned intermediate the centralportion 1002 and the base 1004.

The sensor arrangement 1048 can include one or more resistive straingauges, optical force sensors, optical distance sensors, miniaturecameras in the range of about 1.0 mm to about 3.0 mm in size, and/ortime of flight sensors utilizing a pulsed light source, for example. Inone aspect, the sensor arrangement 1048 includes a plurality ofresistive strain gauges configured to detect the different force vectorsapplied thereto. The strain gauges can define a Wheatstone bridgeconfiguration, for example. Additionally or alternatively, the sensorarrangement 1048 can include a plurality of optoelectronic sensors, suchas measuring cells comprising a position-sensitive detector illuminatedby a light-emitting element, such as an LED. Alternative force-detectingsensor arrangements are also contemplated. Exemplary multi-dimensionalinput devices and/or sensor arrangements are further described in thefollowing references, which are incorporated by reference herein intheir respective entireties:

-   -   U.S. Pat. No. 4,785,180, titled OPTOELECTRIC SYSTEM HOUSED IN A        PLASTIC SPHERE, issued Nov. 15, 1988;    -   U.S. Pat. No. 6,804,012, titled ARRANGEMENT FOR THE DETECTION OF        RELATIVE MOVEMENTS OR RELATIVE POSITION OF TWO OBJECTS, issued        Oct. 12, 2004;    -   European Patent Application No. 1,850,210, titled OPTOELECTRONIC        DEVICE FOR DETERMINING RELATIVE MOVEMENTS OR RELATIVE POSITIONS        OF TWO OBJECTS, published Oct. 31, 2007;    -   U.S. Patent Application Publication No. 2008/0001919, titled        USER INTERFACE DEVICE, published Jan. 3, 2008; and    -   U.S. Pat. No. 7,516,675, titled JOYSTICK SENSOR APPARATUS,        issued Apr. 14, 2009.

Referring again to the input control device 1000 in FIGS. 6-11 , ajoystick 1008 extends from the central portion 1002. Forces exerted onthe central portion 1002 via the joystick 1008 define input motions forthe sensor arrangement 1048. For example, the sensor arrangement 1048(FIGS. 8 and 9 ) in the base 1004 can be configured to detect the inputforces and moments applied by a surgeon to the joystick 1008. Thejoystick 1008 can be spring-biased toward a central, or home, position,in which the joystick 1008 is aligned with the Z axis, a vertical axisthrough the joystick 1008, central portion 1002, and the space joint1006. Driving (e.g. pushing and/or pulling) the joystick 1008 away fromthe Z axis in any direction can be configured to “drive” an end effectorof an associated surgical tool in the corresponding direction. When theexternal driving force is removed, the joystick 1008 can be configuredto return to the central, or home, position and motion of the endeffector can be halted. For example, the central portion 1002 andjoystick 1008 can be spring-biased toward the home position.

In various instances, the space joint 1006 and the joystick 1008 coupledthereto define a six degree-of-freedom input control. Referring againnow to the end effector 1052 of the surgical tool 1050 in FIG. 12 , theforces on the joystick 1008 of the input control device 1000 in the Xdirection correspond to displacement of the end effector 1052 along theX_(t) axis thereof (e.g. longitudinally), forces on the joystick 1008 inthe Y direction correspond to displacement of the end effector 1052along the Y_(t) axis thereof (e.g. laterally), and forces on thejoystick 1008 in the Z direction correspond to displacement of the endeffector 1052 along the Z_(t) axis (e.g. vertically/up and down).Additionally, forces on the joystick 1008 about the X axis (the momentforces R) result in rotation of the end effector 1052 about the X_(t)axis (e.g. a rolling motion about a longitudinal axis in the directionR_(t)), forces on the joystick 1008 about the Y axis (the moments forcesP) result in articulation of the end effector 1052 about the Y_(t) axis(e.g. a pitching motion in the direction Pt), and forces on the joystick1008 about the Z axis (the moment forces T) result in articulation ofthe end effector 1052 about the Z_(t) axis of the end effector (e.g. ayawing or twisting motion in the direction T_(t)). In such instances,the input control device 1000 comprises a six-degree of freedomjoystick, which is configured to receive and detect sixdegrees-of-freedom-forces along the X, Y, and Z axes and moments aboutthe X, Y, and Z axes. The forces can correspond to translational inputand the moments can correspond to rotational inputs for the end effector1052 of the associated surgical tool 1050. Six degree-of-freedom inputdevices are further described herein. Additional degrees of freedom(e.g. for actuating the jaws of an end effector or rolling the endeffector about a longitudinal axis) can be provided by additional jointssupported by the joystick 1008, as further described herein.

In various instances, the input control device 1000 includes a wrist orjoint 1010 that is offset from the space joint 1006. The wrist 1010 isoffset from the space joint 1006 by a shaft, or lever, 1012 extendingalong the shaft axis S that is parallel to the axis X in theconfiguration shown in FIG. 6 . For example, the joystick 1008 canextend upright vertically from the central portion 1002 and the base1004, and the joystick 1008 can support the shaft 1012.

As further described herein, the space joint 1006 can define the inputcontrol motions for multiple degrees of freedom. For example, the spacejoint 1006 can define the input control motions for translation of thesurgical tool in three-dimensional space and articulation of thesurgical tool about at least one axis. Rolling motions can also becontrolled by inputs to the space joint 1006, as further describedherein. Moreover, the wrist 1010 can define input control motions for atleast one degree of freedom. For example, the wrist 1010 can define theinput control motions for the rolling motion of the end effector.Moreover, the wrist 1010 can support an end effector actuator 1020,which is further described herein, to apply open and closing motions tothe end effector.

In certain instances, the rolling, yawing, and pitching motions of theinput control device 1000 are translatable motions that definecorresponding input control motions for the related end effector. Invarious instances, the input control device 1000 can utilize adjustablescaling and/or gains such that the motion of the end effector isscalable in relationship to the control motions delivered at the wrist1010.

In one aspect, the input control device 1000 includes a plurality ofmechanical joints, which can be elastically-coupled components, sliders,journaled shafts, hinges, and/or rotary bearings, for example. Themechanical joints include a first joint 1040 (at the space joint 1006)intermediate the base 1004 and the central portion 1002, which allowsrotation and tilting of the central portion 1002 relative to the base1004, and a second joint 1044, which allows rotation of the wrist 1010relative to the joystick 1008. In various instances, six degrees offreedom of a robotic end effector (e.g. three-dimensional translationand rotation about three different axes) can be controlled by userinputs at only these two joints 1040, 1044, for example. With respect tomotion at the first joint 1040, the central portion 1002 can beconfigured to float relative to the base 1004 at elastic couplings, asfurther described herein. With respect to the second joint 1044, thewrist 1010 can be rotatably coupled to the shaft 1012, such that thewrist 1010 can rotate in the direction R (FIG. 6 ) about the shaft axisS. Rotation of the wrist 1010 relative to the shaft 1012 can correspondto a rolling motion of an end effector about a central tool axis, suchas the rolling of the end effector 1052 about the X_(t) axis. Rotationof the wrist 1010 by the surgeon to roll an end effector providescontrol of the rolling motion at the surgeon's fingertips andcorresponds to a first-person perspective control of the end effector(i.e. from the surgeon's perspective, being “positioned” at the jaws ofthe remotely-positioned end effector at the surgical site). As furtherdescribed herein, such placement and perspective can be utilized tosupply precision control motions to the input control device 1000 duringportions of a surgical procedure (e.g. a precision motion mode).

The various rotary joints of the input control device can include asensor arrangement configured to detect the rotary input controlsapplied thereto. The wrist 1010 can include a rotary sensor (e.g. thesensor 1049 in FIG. 25 ), which can be a rotary force/torque sensorand/or transducer, rotary strain gauge and/or strain gauge on a spring,rotary encoder, and/or an optical sensor to detect rotary displacementat the joint, for example.

In certain instances, the input control device 1000 can include one ormore additional joints and/or hinges for the application of rotationalinput motions corresponding to articulation of an end effector. Forexample, the input control device 1000 can include a hinge along theshaft 1012 and/or between the shaft 1012 and the joystick 1008. In oneinstance, hinged input motions at such a joint can be detected byanother sensor arrangement and converted to rotary input control motionsfor the end effector, such as a yawing or pitching articulation of theend effector. Such an arrangement requires one or more additional sensorarrangements and would increase the mechanical complexity of the inputcontrol device.

The input control device 1000 also includes the end effector actuator1020. The end effector actuator 1020 includes opposing fingers 1022extending from the wrist 1010 toward the joystick 1008 and the centralportion 1002 of the space joint 1006. The opposing fingers 1022 extenddistally beyond the space joint 1006. In such instances, the wrist 1010is proximal to the space joint 1006, and the distal ends 1024 of theopposing fingers 1022 are distal to the space joint 1006, which mirrorsthe jaws being positioned distal to the articulation joints of a robotictool, for example. Applying an actuation force to the opposing fingers1022 comprises an input control for a surgical tool. For example,referring again to FIG. 12 , applying a pinching force to the opposingfingers 1022 can close and/or clamp the jaws 1054 of the end effector1052 (see arrows C in FIG. 12 ). In various instances, applying aspreading force can open and/or release the jaws 1054 of the endeffector 1052, such as for a spread dissection task, for example. Theend effector actuator 1020 can include at least one sensor for detectinginput control motions applied to the opposing fingers 1022. For example,the end effector actuator can include a displacement sensor and/or arotary encoder for detecting the input control motions applied to pivotthe opposing fingers 1022 relative to the shaft 1012.

In various instances, the end effector actuator 1020 can include one ormore loops 1030, which are dimensioned and positioned to receive asurgeon's digits. For example, referring primarily to FIGS. 10 and 11 ,the surgeon's thumb T is positioned through one of the loops 1030 andthe surgeon's middle finger M is positioned through the other loop 1030.In such instances, the surgeon can pinch and/or spread his thumb T andmiddle finger M to actuate the end effector actuator 1020. In otherinstances, the loops 1030 can be structured to receive more than onedigit and, depending on the placement of the loops 1030, differentdigits may engage the loops. In various instances, the finger loops 1030can facilitate spread dissection functions and/or translation of therobotic tool upward or downward (i.e. the application of a verticalforce at the space joint 1006, for example). In certain instances, theloops 1030 can define complete loops; however, in other instances,partial loops (e.g. half-circles) can be utilized. In still otherinstances, the end effector actuator 1020 may not include the loops1030. For example, the end effector actuator 1020 can be spring-biasedoutwardly such that loops are not needed to draw the opposing fingers1022 apart, such as for spread dissection functions.

The opposing fingers 1022 of the end effector actuator 1020 define aline of symmetry that is aligned with the longitudinal shaft axis Salong which the shaft 1012 extends when the fingers 1022 are inunactuated positions. The line of symmetry is parallel to the axis Xthrough the multi-dimensional space joint 1006. Moreover, the centralaxis of the joystick 1008 is aligned with the line of symmetry. Invarious instances, the motion of the opposing fingers 1022 can beindependent. In other words, the opposing fingers 1022 can be displacedasymmetrically relative to the longitudinal shaft axis S during anactuation. The displacement of the opposing fingers 1022 can depend onthe force applied by the surgeon, for example. With certain surgicaltools, the jaws of the end effector can pivot about an articulation axissuch that various closed positions of the jaws are not longitudinallyaligned with the shaft of the surgical tool. Moreover, in certaininstances, it can be desirable to hold one jaw stationary, such asagainst fragile tissue and/or a critical structure, and to move theother jaw relative to the non-moving jaw. To accommodate such closuremotions, the range of motion of the opposing fingers 1022 on the inputcontrol device 1000 can be larger than the range of motion of the jawsof the end effector, for example. For example, referring to FIG. 12A,the surgical tool 1050′ is shown in an articulated configuration inwhich the jaws can be clamped together out of alignment with alongitudinal shaft axis of the surgical tool 1050′. In such instances,the jaws and, thus the fingers 1022 on the input control device 1000(FIGS. 6-11 ) would be actuated asymmetrically to move the jaws of theend effector 1052 to a closed configuration.

Referring now to FIGS. 13A-15B, various control motions applied to theend effector actuator 1020 and corresponding actuations of an endeffector 1062 are shown. The end effector 1062 includes opposing jaws1064 that are movable between an open configuration (FIG. 13A), anintermediate configuration (FIG. 14A), and a closed configuration (FIG.15A) as the opposing fingers 1022 of the end effector actuator 1020 movebetween an open configuration (FIG. 13B), an intermediate configuration(FIG. 14B), and a closed configuration (FIG. 15B), respectively.

The input control device 1000 also includes at least one additionalactuator, such as the actuation buttons 1026, 1028, for example, whichcan provide additional controls at the surgeon's fingertips. Forexample, the actuation buttons 1026, 1028 are positioned on the joystick1008 of the input control device 1000 such that the surgeon can accessthe buttons 1026, 1026 with a digit, such as an index finger I. Theactuation buttons 1026, 1028 can correspond to buttons for activatingthe surgical tool, such as firing, extending, activating, translating,and/or retracting a knife, energizing one or more electrodes, adjustingan energy modularity, affecting diagnostics, biopsy sampling, ablation,and/or other surgical tasks, for example. In other instances, theactuation buttons 1026, 1028 can provide inputs to an imaging system toadjust a view of the surgical tool, such as zooming in/out, panning,tracking, titling and/or rotating, for example. In certain instance theactuators can be positioned in different locations than the actuationbuttons 1026, 1028, such as positioned for use by a thumb or anotherdigit, for example. Additionally or alternatively, the actuators can beprovided on a touch screen and/or foot pedal, for example.

Referring primarily now to FIGS. 10 and 11 , a user is configured toposition his or her hand relative to the input control device 1000 suchthat the wrist 1010 is proximal to the space joint 1006. Morespecifically, the user's palm is positioned adjacent to the wrist 1010and the user's fingers extend distally toward the joystick 1008 and thecentral portion 1002 of the space joint 1006. Distally-extending fingers1022 (for actuation of the jaws) and the actuation buttons 1026, 1028(for actuation of a surgical function at the jaws) are distal to thespace joint 1006 and wrist 1010. Such a configuration mirrors theconfiguration of a surgical tool in which the end effector is distal toa more-proximal articulation joint(s) and/or rotatable shaft and, thus,provides an intuitive arrangement that facilitates a surgeon's trainingand adoption of the input control device 1000.

In various instances, a clutch-less input control device including a sixdegree-of-freedom input control, an end effector actuator, andadditional actuation buttons can define alternative geometries to theinput control device 1000. Stated differently, a clutch-less inputcontrol device does not prescribe the specific form of the joystickassembly of the input control device 1000. Rather, a wide range ofinterfaces may be designed based on formative testing and userpreferences. In various instances, a robotic system can allow for usersto choose from a variety of different forms to select the style thatbest suits his/her needs. For example, a pincher, pistol, ball, pen,and/or a hybrid grip, among other input controls, can be supported.Alternative designs are further described herein and in variouscommonly-owned patent applications that have been incorporated byreference herein in their respective entireties.

In various instances, the input controls for the input control device1000 are segmented between first control motions and second controlmotions. For example, first control motions and/or parameters thereforcan be actuated in a first mode and second control motions and/orparameters therefor can be actuated in a second mode. The mode can bebased on a factor provided by the surgeon and/or the surgical robotcontrol system and/or detected during the surgical procedure. Forexample, the mode can depend on the proximity of the surgical tool totissue, such as the proximity of the surgical tool to the surface oftissue and/or to a critical structure. Various distance determiningsystems for determining proximity to one or more exposed and/or at leastpartially hidden critical structures are further described herein.

In one instance, referring now to FIG. 25 , the input control device1000 can be communicatively coupled to a control circuit 832 of acontrol system 833, which is further described herein. In the controlsystem 833, the control circuit 832 can receive input signals from theinput control device 1000, such as feedback detected by the varioussensors therein and related to control inputs at the joystick 1008and/or wrist 1010 and/or outputs from the various sensors thereon (e.g.the sensor arrangement 1048 and/or the rotary sensor 1049 at the wrist1010. For example, signals detected by the sensor arrangement 1048, i.e.the multi-axis force and torque sensor of the space joint 1006, can beprovided to the control circuit 832. Additionally, signals detected bythe sensor 1049, i.e., the rotary sensor of the wrist 1010, can beprovided to the control circuit 832. A memory 834 for the control system833 also includes control logic for implementing the input controlsprovided to the input control device 1000 and detected by the varioussensors (e.g. the sensors 1048 and 1049).

Referring now to FIG. 11A, control logic 1068 for the input controldevice 1000 can implement a first mode 1070 if the distance determinedby a distance determining subsystem is greater than or equal to acritical distance and can implement a second mode 1072 if the distancedetermined by the distance determining subsystem is less than thecritical distance. The control logic can be utilized in the controlcircuit 832, a control circuit 1400 (FIG. 11C), a combinational logicalcircuit 1410 (FIG. 11D), and/or a sequential logic circuit 1420 (FIG.11E), for example, where an input is provided from inputs to the inputcontrol device 1000 (FIGS. 6-11 ) and/or a surgical visualization systemor distance determining subsystem thereof, as further described herein.

For example, turning to FIG. 11C, the control circuit 1400 can beconfigured to control aspects of the input control device 1000,according to at least one aspect of this disclosure. The control circuit1400 can be configured to implement various processes described herein.The control circuit 1400 may comprise a microcontroller comprising oneor more processors 1402 (e.g., microprocessor, microcontroller) coupledto at least one memory circuit 1404. The memory circuit 1404 storesmachine-executable instructions that, when executed by the processor1402, cause the processor 1402 to execute machine instructions toimplement various processes described herein. The processor 1402 may beany one of a number of single-core or multicore processors known in theart. The memory circuit 1404 may comprise volatile and non-volatilestorage media. The processor 1402 may include an instruction processingunit 1406 and an arithmetic unit 1408. The instruction processing unit1406 may be configured to receive instructions from the memory circuit1404 of this disclosure.

FIG. 11D illustrates the combinational logic circuit 1410 that can beconfigured to control aspects of the input control device 1000,according to at least one aspect of this disclosure. The combinationallogic circuit 1410 can be configured to implement various processesdescribed herein. The combinational logic circuit 1410 may comprise afinite state machine comprising a combinational logic 1412 configured toreceive data associated with the input control device 1000 (FIGS. 6-11 )and a surgical visualization system and/or distance determiningsubsystem thereof from an input 1414, process the data by thecombinational logic 1412, and provide an output 1416.

FIG. 11E illustrates a sequential logic circuit 1420 configured tocontrol aspects of the input control device 1000 (FIGS. 6-11 ),according to at least one aspect of this disclosure. For example, thesequential logic circuit 1420 or the combinational logic 1422 can beconfigured to implement various processes described herein. Thesequential logic circuit 1420 may comprise a finite state machine. Thesequential logic circuit 1420 may comprise a combinational logic 1422,at least one memory circuit 1424, and a clock 1429, for example. The atleast one memory circuit 1424 can store a current state of the finitestate machine. In certain instances, the sequential logic circuit 1420may be synchronous or asynchronous. The combinational logic 1422 isconfigured to receive data associated with the input control device 1000(FIGS. 6-11 ) and a surgical visualization system and/or distancedetermining subsystem thereof from an input 1426, process the data bythe combinational logic 1422, and provide an output 1428. In otheraspects, the circuit may comprise a combination of a processor (e.g.,processor 1402 in FIG. 11C) and a finite state machine to implementvarious processes herein. In other aspects, the finite state machine maycomprise a combination of a combinational logic circuit (e.g.,combinational logic circuit 1410 in FIG. 11D) and the sequential logiccircuit 1420. Control circuits similar to the control circuits 1400,1410, and 1420 can also be utilized to control various aspects of asurgical robot and/or surgical visualization system, as furtherdescribed herein.

In various instances, the input control device 1000 is configured tooperate in different modes, such as a gross mode and a precision mode,for example. The variation in control motions in the different modes canbe accomplished by selecting a preset scaling profile. For example,control motions with the multi-dimensional space joint 1006 can bescaled up for gross mode such that small forces on the space joint 1006result in significant displacements of the end effector. Moreover, thecontrol motions with the wrist 1010 can be scaled down for precisionmode such that large moments at the wrist 1010 result in fine rotationaldisplacements of the end effector. The preset scaling profile can beuser-selected and/or depend on the type and/or complexity of a surgicalprocedure and/or the experience of the surgeon, for example. Alternativeoperational modes and settings are also contemplated.

Referring again to FIG. 11A, in certain instances, the first mode 1070can correspond to a gross control mode and the second mode 1072 cancorrespond to a precision control mode. One or more user inputs to thespace joint 1006 can correspond to control inputs to affect gross motionof the surgical tool in the first mode 1070, such as the largedisplacements of the surgical tool toward the surgical site. One or moreinputs to the wrist 1010 can define the rotational displacements of thesurgical tool, such as the rolling rotary displacement of the surgicalend effector at the surgical site. The segmented controls can beselectively locked out, such that rolling rotational inputs at the wrist1010 are disabled during portions of a surgical procedure and one ormore inputs at the space joint 1006 are disabled during other portionsof the surgical procedure. For example, it can be desirable to lock outthe rolling rotational inputs during the first mode 1070, such as whenthe surgical end effector is positioned outside a threshold proximityzone around a surgical site and/or critical structure. Moreover, invarious instances, the control motions for the space joint 1006 and/orthe wrist 1010 can be scaled up or down based on input from the distancedetermining system. The scaling parameters for the control motionsprovided to the space joint 1006 and the wrist 1010 can be different inthe first mode 1070 and the second mode 1072. For example, the velocityof the robotic tool can be slowed down during a precision motion modeand sped up during a gross motion mode.

Referring now to FIG. 11B, a table depicting scaling scenarios invarious operational modes is depicted. An input control device, such asthe input control device 1000 (FIGS. 6-11 ) can be configured to receiveat least six different inputs (e.g. Input A, Input B, etc.)corresponding to six degrees of freedom of a surgical tool coupledthereto. The inputs can be scaled based on the operational mode (e.g.the first mode 1070, the second mode 1072, etc.), which is determined byan input to the control circuit, such as proximity data from a distancedetermining subsystem of a surgical visualization system, for example. Afirst list of rules 1074 comprises first control parameters forcontrolling the surgical tool based on input from the input controldevice 1000. A second list of rules 1076 comprise second controlparameters for controlling the surgical tool based on input from theinput control device 1000. In certain instances, such as when an inputis “locked out”, the variable value in the list of rules 1074, 1076 canbe zero. Additional modes and additional rules/control parameters arecontemplated.

In various aspects, the gross motions described in the presentdisclosure are gross translational motions characterized by speedsselected from a range of about 3 inches/second to about 4 inches/second.In at least one example, a gross translational motion, in accordancewith the present disclosure, is about 3.5 inches/second. In variousaspects, by contrast, the fine motions described in the presentdisclosure can be fine translational motions characterized by speedsless than or equal to 1.5 inch/second. In various aspects, the finemotions described in the present disclosure can be fine translationalmotions characterized by speeds selected from a range of about 0.5inches/second to about 2.5 inches/second.

In various aspects, the gross motions described in the presentdisclosure are gross rotational motions characterized by speeds selectedfrom a range of about 10 radians/second to about 14 radians/second. Inat least one example, a gross rotational motion, in accordance with thepresent disclosure, is about 12.6 radians/second. In various aspects, bycontrast, the fine motions described in the present disclosure can befine rotational motions characterized by speeds selected from a range ofabout 2 radians/second to about 4 radians/second. In at least oneexample, a fine rotational motion, in accordance with the presentdisclosure, is about 2.3 radians/second.

In various aspects, the gross motions of the present disclosure are twoto six times greater than the fine motions. In various aspects, thegross motions of the present disclosure are three to five times greaterthan the fine motions.

As described herein, the space joint 1006 can define input controlmotions for six degrees of freedom. For example, the space joint 1006can define the input control motions for non-rotational translation ofthe surgical tool in three-dimensional space and rotation of thesurgical tool about three different axes. In such instances, thejoystick 1008 is configured to receive inputs in three-dimensional spaceand about three axes of rotation. Moreover, the end effector actuator1020 (e.g. a jaw closure mechanism) is built into a sixdegree-of-freedom joystick assembly comprising the joystick 1008 andassociated sensors in the base 1004. The input control motions from thespace joint 1006 can be selectively locked out and/or scaled duringdifferent portions of a surgical procedure.

An exemplary six-degree of freedom input control device 1100 is depictedin FIGS. 18-22 . In various instances, such an input device can beincorporated into a user input device for a surgical robot, such as theinput control device 1000 (FIGS. 6-11 ), for example. The input controldevice 1100 includes a frame or base 1101, which typically remainsstationary on a surface such as a desk or table during use, and a cap1102, which is movably mounted on the base 1101 and forms the inputmechanism by which a user may input movements that are detected andinterpreted by the input control device 1100. In particular, the cap1102 of the input control device 1100 is designed to be grasped by theuser and manipulated relative to the base 1101 to generate the desiredinput. To determine the relative movements or positions of the cap 1102and base 1101, the input control device 1100 includes a first boardmember 1110 fixed relative to the base 1101 of the input control device1100, a second board member 1120 resiliently mounted in spaced relationto the first board member 1110 and adapted for movement or displacementrelative thereto, and a plurality of optoelectronic measuring cells 1118for determining relative movements or displacements between the firstand second board members 1110, 1120. The second board member 1120 iselastically connected to the first board 1110 by a plurality ofequally-spaced coil spring elements 1106.

Each of the measuring cells 1118 for determining the relative movementsand/or positions of the first and second boards 1110, 1120 comprises alight emitting element in the form of an infrared light-emitting diode(ILED) 1113 (FIGS. 18 and 19 ) projecting from on an upper side thefirst board 1110 and a position-sensitive infrared detector (PSID) 1123(FIG. 20 ) mounted on an underside of the second board 1120 and facingthe first board 1110. Furthermore, a light shield housing 1130 isprovided between the first board 1110 and the second board 1120 foreffectively housing the ILEDs 1113 and for shielding the PSIDs 1123 fromany unwanted or extraneous light that might otherwise affect theaccuracy of the readings the PSIDs 1123 provide.

The light shield housing 1130 has a generally hollow structure with anumber of cavities 1131 defined therein that form individual light-pathchannels between each ILED 1113 on the first board 1110 and itsrespective PSID 1123 mounted on the second board 1120. Furthermore, asshown in FIG. 19 , the light shield housing 1130 includes slitdiaphragms 1132 formed in a top wall 1133 thereof such that each of theslit diaphragms 1132 is arranged in the light-path between an ILED 1113and the respective PSID 1123 that the ILED 1113 is intended toilluminate.

The light shield housing 1130 is thus configured to define a pluralityof light beam paths between the ILEDs 1113 on the first board 1110 andthe PSIDs 1123 on the second board 1120, such that each of the lightbeam paths is arranged to extend at an angle in the range of about 30°to about 60° (and preferably at about 45°) relative to the plane of thefirst board 1110, i.e. relative to a base reference plane for the inputcontrol device 1100. Furthermore, the light beam paths which are definedby the light-path channels 1131 formed along each side of the lightshield housing 1130 thereby extend in three separate, intersectingplanes corresponding to the planes of the housing sides. That is, thelight beam paths of the two measuring cells 1118 having a common PSID1123 may be considered to lie within the same plane. The light shieldhousing 1130 is thereby designed to form a three-dimensional array oflight beam paths between the ILEDs 1113 and the PSIDs 1123. This, inturn, provides for a particularly compact optoelectronic device 1100,while also affording great flexibility in modifications to the shape ofthe light shield housing 1130.

With further reference to FIG. 20 , because each of the PSIDs 1123 isilluminated by two separate ILEDs 1113, each of the sides of thegenerally three-sided light shield housing 1130 is divided into twoseparate light-path channels 1131 by a central dividing wall 1114. Inthis way, each PSID 1123 is illuminated by its two separate ILEDs 1113via two separate slit diaphragms 1132. Each of the slits 1132 providesoptical communication with the associated PSID for only one of the ILEDs1113. That is, each ILED 1113 is provided with its own dedicated slitdiaphragm 1132. The slit diaphragms 1132 of each pair are arrangedsubstantially parallel and extend generally perpendicular to alight-sensitive part of the associated PSID 1123.

Referring primarily to FIG. 18 , the optoelectronic device 1100 furtherincludes a stop arrangement 1140, which is designed to provide aphysical barrier to movement or displacement of the second board 1120relative to the first board 1110 beyond a specific predetermined limit.The stop arrangement 1140 thereby prevents any inadvertent overloadingof the input control device 1100 during use. The stop arrangement 1140includes a plate-like connecting member 1142 and pin member 1141.

Openings or holes 1124 formed through the second board 1120 have adiameter substantially larger than the diameter of the pin members 1141they receive. In the neutral position of the second board 1120 relativeto the first board 1110, each of the pin members 1141 can be positionedsubstantially centrally in its respective hole 1124 through the secondboard 1120. By virtue of the resilient deformability of the three coilspring elements 1106 connecting the board members 1110, 1120, the secondboard 1120 is able to move laterally and rotationally in a planeparallel to the first board 1110 within the limits defined by the holes1124 and the sides of the pin members 1141. As shown in FIG. 21 , as thesecond board 1120 is rotated counterclockwise from its neutral positionrelative to the first board 1110 against the bias of the coil springelements 1106, the edges of the holes 1124 eventually engage the lateralsides of the pin members 1141, which in turn act as a stop and preventfurther rotation of the second board 1120. The same effect naturallyalso occurs for clockwise rotations or lateral translations of thesecond board 1120. In various instances, elastomeric elements 1107 inthe form of foam blocks, for example, can form a cushion for the pinmembers 1141 of the stop arrangement 1140.

With particular reference to FIG. 22 , when a tilting (i.e. rotational)movement is applied to the second board 1120 (via the cap 1102) asshown, the second board 1120 will deflect until, after a predeterminedamount of tilting has occurred, the second board 1120 engages theplate-like connecting member 1142 in an angled peripheral region 1143.The contact or engagement with the angled peripheral region 1143 of thefixed plate-like connecting member 1142 acts to stop further relativemovement of the second board 1120 in that direction. Simultaneously, oreven alternatively, an upper inside surface of the cap 1102 may engage acorresponding angled peripheral region 1143 of the plate-like connectingmember 1142 as indicated in FIG. 22 . The first board 1110, the lightshield housing 1130 and the stop arrangement 1140 can all remainstationary relative to the frame of the input control device 1100, whilethe cap 1102 and the second board 1120 are moved relative thereto duringoperation of the device. The input control device 1100 as well asvarious alternative designs and/or features thereof are furtherdescribed in European Patent Application No. 1,850,210, titledOPTOELECTRONIC DEVICE FOR DETERMINING RELATIVE MOVEMENTS OR RELATIVEPOSITIONS OF TWO OBJECTS, published Oct. 31, 2007, which is incorporatedby reference herein in its entirety.

Certain input control devices, such as the input devices at thesurgeon's console 116 in FIGS. 1 and 2 can be bulky and require a largefootprint within an operating room. Additionally, the surgeon can berequired to stay in a predefined location (e.g. sitting at the surgeon'sconsole 116) as long as the surgeon remains actively involved in thesurgical procedure. Additionally, the ergonomics of the input controldevices may be less than desirable for many surgeons and can bedifficult to adjust and/or customize, which can take a toll on thehealth and longevity of the surgeon's career and/or lead to fatiguewithin a surgical case.

A compact input control device, which requires a smaller footprint, canbe incorporated into an adjustable workspace rather than the surgeon'sconsole 116. The adjustable workspace can allow a range of positioningof the input control device. In various instances, one or more compactinput control devices can be positioned and/or moved around theoperating room, such as near a patient table and/or within a sterilefield, such that the surgeon can select a preferred position forcontrolling the robotic surgical procedure without being confined to apredefined location at a bulky surgeon's console. Moreover, theadaptability of the compact input control device can allow the inputcontrol device to be positioned at an adjustable workspace.

For example, referring now to FIGS. 16-17A, the input control device1000 is incorporated into an adjustable workspace 1080 for a surgeon.The adjustable workspace 1080 includes a surface or desk 1082 and amonitor 1088 for viewing the surgical procedure via the endoscope. Thedesk 1082 and/or the monitor 1088 can be repositioned at differentheights. In various instances, a first height can be selected such thatthe surgeon can stand at the desk 1082 and, at a different time, asecond height can be selected such that the surgeon can sit at the desk1082. Additionally or alternatively, the sitting and standing heightscan be adjusted for different surgeons. Moreover, the desk 1082 can bemoved relative to the monitor 1088 and the monitor 1088 can be movedrelative to the desk 1082. For example, the desk 1082 and/or the monitor1088 can be supported on releasably lockable wheels or casters.Similarly, a chair can be moved relative to the desk 1082 and themonitor 1088. In such instances, the X, Y, and Z positions of thevarious components of the adjustable workspace 1080 can be customized bythe surgeon.

The desk 1082 includes a foot pedal board 1086; however, in otherinstances, a foot pedal board 1086 may not be incorporated into the desk1082. In certain instances, the foot pedal board 1086 can be separatefrom the desk 1082, such that the position of the foot pedal board 1086relative to the desk 1082 and/or chair can be adjustable as well.

In various instances, the adjustable workspace 1080 can be modular andmoved toward the patient table or bedside. In such instances, theadjustable workspace 1080 can be draped with a sterile barrier andpositioned within the sterile field. The adjustable workspace 1080 canhouse and/or support the processors and/or computers for implementingthe teleoperation of the surgical robot from inputs to the input controldevice 1000 at the adjustable workspace 1080. Moreover, the desk 1082includes a platform or surface 1084 that is suitable for supporting thearm(s)/wrist(s) of the surgeon with limited mechanical adjustmentsthereto.

Owing to the smaller size and reduced range of motion of the inputcontrol device 1000, as well as the adjustability of the workspace 1080,the surgeon's console can define a low profile and require a smallerfootprint in the operating room. Smaller consoles can provide more spacein the operating room. Additionally, the smaller footprint can allowmultiple users (e.g. an experienced surgeon and less experienced surgeonor trainee, such as a medical student or resident) to cooperativelyperform a surgical procedure in close proximity, which can facilitatetraining. The small input control devices can be utilized in astimulator or real system, for example, and can be remote to thesurgical theater and/or at the robotic surgical system.

Referring primarily to FIGS. 16 and 17A, the adjustable workspace 1080also supports additional axillary devices. For example, a keyboard 1090and a touchpad 1092 are supported on the surface 1084 of the desk 1082.Alternative axillary devices are also contemplated, such as atraditional computer mouse and other imaging and diagnostic equipmentsuch as registered magnetic resonance imaging (MRI) or computerizedtomography (CT) scan data, images, and medical histories, for example.The axillary devices can control the graphical user interface on themonitor 1088, and the input control devices 1000 can control theteleoperation of the surgical robot. In such instances, the two distinctcontrol inputs allow the surgeon to control teleoperation functionsusing the clutch-less, input control device(s) 1000 while engaging withthe graphical user interface on the monitor 1088 with more conventionaltechniques. As a result, the user can interact with applications on themonitor 1088 concurrently with the teleoperation of the surgical robot.Moreover, the dual, segregated control input creates a clear cognitivedistinction between the teleoperation environment and the graphical userinterface environment.

In various instances, an adjustable workspace for the surgeon can bedesired. For example, the surgeon may want to be free and/or untetheredand/or unconfined to a predefined location at the surgeon's console, asfurther described herein. In certain instances, a surgeon may want torelocate during a surgical procedure. For example, a surgeon may want to“scrub in” quickly during a surgical procedure and enter the sterilefield in order to view the surgical procedure and/or the patientin-person, rather than on a video monitor. Moreover, a surgeon may notwant to give up control of the surgical robot as the surgeon relocates.

A mobile input control device can allow the surgeon to relocate and evenenter the sterile field during a surgical procedure. The mobile inputcontrol device can be modular, for example, and compatible withdifferent docking stations within an operating room. In variousinstances, the mobile portion of the input control device can be asingle-use device, which can be sterilized for use within the sterilefield.

As an example, referring now to FIG. 23 , an input control device 1200is shown. The input control device 1200 includes a base 1204, which issimilar to the base 1004 of the input control device 1000 in manyrespects. The input control device 1200 can include a multi-axis forceand torque sensor 1203, as described herein, which is configured todetect forces and moments applied to the base 1204 by a modular joystickcomponent 1208, which is similar to the joystick 1008 in many respects.The modular joystick component 1208 can be releasably docked in the base1204 to apply forces for detection by the sensor 1203 housed therein. Ashaft 1212, which is similar to the shaft 1012 in many respects, extendsfrom the joystick 1208 and supports at least one movable finger 1222,which is similar to the fingers 1022 in many respects. Similar to theinput control device 1000, the input control device 1200 can alsoinclude a wrist rotatably coupled to the modular joystick component1208, which can be rotated to supply control motions such as a rollingcontrol motion for a surgical end effector. For example, the shaft 1212can include a wrist component at a proximal end 1225 thereof.

In operation, the input control device 1200 can be engaged by the handof a surgeon. Forces applied by the surgeon's hand are detected andcorresponding signals are conveyed to a control unit for controlling arobotic surgical tool in signal communication with the input controldevice 1200. In such instances, forces applied in the X, Y, and Zdirections can correspond to translation of the end effector of thesurgical tool in the X, Y, and Z directions, and moments about the X, Y,and Z axes can correspond to rotation of the end effector about the X,Y, and Z axes. In various instances, controls by the input controldevice 1200 can be segmented based on the detected input and/or positionof the end effector at the surgical site (e.g. proximity to ananatomical and/or critical structure).

The input control device 1200 includes separable components includingthe base 1204, which is separable from the modular joystick component1208. In certain instances, the modular joystick component 1208 can nestand/or fit within an opening 1205 in the base 1204. In variousinstances, the joystick 1208 and the base 1204 can mechanically andelectrically couple. In various instances, the opening 1205 in the base1204 can include a registration key, which allows the joystick component1208 to be received within the opening 1205 at a set angularorientation, such that the position of the modular joystick component1208 relative to the base 1204 is known.

In various instances, the modular joystick component 1208 and the base1204 can include communication modules that enable communicationtherebetween. Because the communication does not require high poweredsignals, near-field communication protocols can be utilized in variousinstances. A sterile barrier 1230 can extend between the modularcomponents of the input control device 1200. The sterile barrier 1230 isa thin and flexible sheet positioned between the modular components, forexample. Near-field communication signals can travel through such alayer of material. The sterile barrier 1230 can define a drape or sheetthat covers the base 1204, for example. In one aspect, the drape caninclude a thin element of plastic or elastomeric material forpositioning, location, and transference of forces.

In certain instances, the base 1204 can be positioned in the sterilefield during a surgical procedure. For example, the base 1204 can bemounted onto a bedrail 1232 and/or table adjacent to the patient. Incertain instances, the base 1204 can be a reusable or multi-usecomponent of the input control device 1200. A plurality of bases 1204can be positioned around a surgical theater, such as a remote surgeon'sconsole outside the sterile field and on the patient table within thesterile field, among other locations, for example.

The joystick component 1208 can be compatible with each base 1204. Invarious instances, the joystick component 1208 can be a disposableand/or single-use component. In other instances, the joystick component1208 can be re-sterilized between uses. For example, the joystickcomponent 1208 can be sterilized (e.g. low-temperature sterilization)and sealed prior to use. When the surgeon moves into the sterile fieldduring a surgical procedure, the sealed joystick component 1208 can beunsealed and ready to use. After the use, the joystick component 1208can be disposed and/or sterilized for a subsequent use.

Visualization Systems

“Digital surgery” can embrace robotic systems, advanced imaging,advanced instrumentation, artificial intelligence, machine learning,data analytics for performance tracking and benchmarking, connectivityboth inside and outside of the operating room (OR), and more. Althoughvarious surgical platforms described herein can be used in combinationwith a robotic surgical system, such surgical platforms are not limitedto use with a robotic surgical system. In certain instances, advancedsurgical visualization can occur without robotics, without thetelemanipulation of robotic tools, and/or with limited and/or optionalrobotic assistance. Similarly, digital surgery can occur withoutrobotics, without the telemanipulation of robotic tools, and/or withlimited and/or optional robotic assistance.

In one instance, a surgical visualization system can include a firstlight emitter configured to emit a plurality of spectral waves, a secondlight emitter configured to emit a light pattern, and one or morereceivers, or sensors, configured to detect visible light, molecularresponses to the spectral waves (spectral imaging), and/or the lightpattern. The surgical visualization system can also include an imagingsystem and a control circuit in signal communication with thereceiver(s) and the imaging system. Based on output from thereceiver(s), the control circuit can determine a geometric surface map,i.e. three-dimensional surface topography, of the visible surfaces atthe surgical site and one or more distances with respect to the surgicalsite. In certain instances, the control circuit can determine one moredistances to an at least partially concealed structure. Moreover, theimaging system can convey the geometric surface map and the one or moredistances to a clinician. In such instances, an augmented view of thesurgical site provided to the clinician can provide a representation ofthe at least partially concealed structure within the relevant contextof the surgical site. For example, the imaging system can virtuallyaugment the concealed structure on the geometric surface map of theconcealing and/or obstructing tissue similar to a line drawn on theground to indicate a utility line below the surface. Additionally oralternatively, the imaging system can convey the proximity of one ormore surgical tools to the visible and obstructing tissue and/or to theat least partially concealed structure and/or the depth of the concealedstructure below the visible surface of the obstructing tissue. Forexample, the visualization system can determine a distance with respectto an augmented line on the surface of the visible tissue and convey thedistance to the imaging system. In various instances, the surgicalvisualization system can gather data and convey informationintraoperatively.

FIG. 24 depicts a surgical visualization system 500 according to atleast one aspect of the present disclosure. The surgical visualizationsystem 500 may be incorporated into a robotic surgical system, such as arobotic system 510. The robotic system 510 can be similar to the roboticsystem 110 (FIG. 1 ) and the robotic system 150 (FIG. 3 ) in manyrespects. Alternative robotic systems are also contemplated. The roboticsystem 510 includes at least one robotic arm, such as the first roboticarm 512 and the second robotic arm 514. The robotic arms 512, 514include rigid structural members and joints, which can includeservomotor controls. The first robotic arm 512 is configured to maneuvera surgical device 502, and the second robotic arm 514 is configured tomaneuver the imaging device 520. A robotic control unit can beconfigured to issue control motions to the robotic arms 512, 514, whichcan affect the surgical device 502 and an imaging device 520, forexample. The surgical visualization system 500 can create a visualrepresentation of various structures within an anatomical field. Thesurgical visualization system 500 can be used for clinical analysisand/or medical intervention, for example. In certain instances, thesurgical visualization system 500 can be used intraoperatively toprovide real-time, or near real-time, information to the clinicianregarding proximity data, dimensions, and/or distances during a surgicalprocedure.

In certain instances, a surgical visualization system is configured forintraoperative, real-time identification of one or more criticalstructures, such as critical structures 501 a, 501 b in FIG. 24 and/orto facilitate the avoidance of the critical structure(s) 501 a, 501 b bya surgical device. In other instances, critical structures can beidentified preoperatively. In this example, the critical structure 501 ais a ureter and the critical structure 501 b is a vessel in tissue 503,which is an organ, i.e. the uterus. Alternative critical structures arecontemplated and numerous examples are provided herein. By identifyingthe critical structure(s) 501 a, 501 b, a clinician can avoidmaneuvering a surgical device too close to the critical structure(s) 501a, 501 b and/or into a region of predefined proximity to the criticalstructure(s) 501 a, 501 b during a surgical procedure. The clinician canavoid dissection of and/or near a vein, artery, nerve, and/or vessel,for example, identified as the critical structure, for example. Invarious instances, the critical structures can be determined on aprocedure-by-procedure basis. The critical structures can be patientspecific.

Critical structures can be structures of interest. For example, criticalstructures can include anatomical structures such as a ureter, an arterysuch as a superior mesenteric artery, a vein such as a portal vein, anerve such as a phrenic nerve, and/or a tumor, among other anatomicalstructures. In other instances, a critical structure can be a foreignstructure in the anatomical field, such as a surgical device, surgicalfastener, clip, tack, bougie, band, and/or plate, for example. Criticalstructures can be determined on a patient-by-patient and/or aprocedure-by-procedure basis. Example critical structures are furtherdescribed herein and in U.S. patent application Ser. No. 16/128,192,titled VISUALIZATION OF SURGICAL DEVICES, filed Sep. 11, 2018, which isincorporated by reference herein in its entirety.

Referring again to FIG. 24 , the critical structures 501 a, 501 b may beembedded in tissue 503. Stated differently, the critical structures 501a, 501 b may be positioned below the surface 505 of the tissue 503. Insuch instances, the tissue 503 conceals the critical structures 501 a,501 b from the clinician's view. The critical structures 501 a, 501 bare also obscured from the view of the imaging device 520 by the tissue503. The tissue 503 can be fat, connective tissue, adhesions, and/ororgans, for example. In various instances, the critical structures 501a, 501 b can be partially obscured from view.

FIG. 24 also depicts the surgical device 502. The surgical device 502includes an end effector having opposing jaws extending from the distalend of the shaft of the surgical device 502. The surgical device 502 canbe any suitable surgical device such as, for example, a dissector, astapler, a grasper, a clip applier, and/or an energy device includingmono-polar probes, bi-polar probes, ablation probes, and/or anultrasonic end effector. Additionally or alternatively, the surgicaldevice 502 can include another imaging or diagnostic modality, such asan ultrasound device, for example. In one aspect of the presentdisclosure, the surgical visualization system 500 can be configured toachieve identification of one or more critical structures and theproximity of the surgical device 502 to the critical structure(s).

The surgical visualization system 500 includes an imaging subsystem thatincludes an imaging device 520, such as a camera, for example,configured to provide real-time views of the surgical site. The imagingdevice 520 can include a camera or imaging sensor that is configured todetect visible light, spectral light waves (visible or invisible),and/or a structured light pattern (visible or invisible), for example.In various aspects of the present disclosure, the imaging system caninclude an imaging device such as an endoscope, for example.Additionally or alternatively, the imaging system can include an imagingdevice such as an arthroscope, angioscope, bronchoscope,choledochoscope, colonoscope, cytoscope, duodenoscope, enteroscope,esophagogastro-duodenoscope (gastroscope), laryngoscope,nasopharyngo-neproscope, sigmoidoscope, thoracoscope, ureteroscope, orexoscope, for example. In other instances, such as in open surgeryapplications, the imaging system may not include a scope.

The imaging device 520 of the surgical visualization system 500 can beconfigured to emit and detect light at various wavelengths, such as, forexample, visible light, spectral light wavelengths (visible orinvisible), and a structured light pattern (visible or invisible). Theimaging device 520 may include a plurality of lenses, sensors, and/orreceivers for detecting the different signals. For example, the imagingdevice 520 can be a hyperspectral, multispectral, or selective spectralcamera, as further described herein. The imaging device 520 can alsoinclude a waveform sensor 522 (such as a spectral image sensor,detector, and/or three-dimensional camera lens). For example, theimaging device 520 can include a right-side lens and a left-side lensused together to record two two-dimensional images at the same time and,thus, generate a three-dimensional image of the surgical site, render athree-dimensional image of the surgical site, and/or determine one ormore distances at the surgical site. Additionally or alternatively, theimaging device 520 can be configured to receive images indicative of thetopography of the visible tissue and the identification and position ofhidden critical structures, as further described herein. For example,the field of view of the imaging device 520 can overlap with a patternof light (structured light) formed by light arrays 530 projected on thesurface 505 of the tissue 503, as shown in FIG. 24 .

Views from the imaging device 520 can be provided to a clinician and, invarious aspects of the present disclosure, can be augmented withadditional information based on the tissue identification, landscapemapping, and the distance sensor system 504. In such instances, thesurgical visualization system 500 includes a plurality of subsystems—animaging subsystem, a surface mapping subsystem, a tissue identificationsubsystem, and/or a distance determining subsystem, as further describedherein. These subsystems can cooperate to intraoperatively provideadvanced data synthesis and integrated information to the clinician(s)and/or to a control unit. For example, information from one or more ofthese subsystems can inform a decision-making process of a clinicianand/or a control unit for an input control device of the robotic system.

The surgical visualization system 500 can include one or more subsystemsfor determining the three-dimensional topography, or surface maps, ofvarious structures within the anatomical field, such as the surface oftissue. Exemplary surface mapping systems include Lidar (light radar),Structured Light (SL), three-dimensional (3D) stereoscopy (stereo),Deformable-Shape-from-Motion (DSfM), Shape-from-Shading (SfS),Simultaneous Localization and Mapping (SLAM), and Time-of-Flight (ToF).Various surface mapping systems are further described herein and in L.Maier-Hein et al., “Optical techniques for 3D surface reconstruction incomputer-assisted laparoscopic surgery”, Medical Image Analysis 17(2013) 974-996, which is incorporated by reference herein in itsentirety and is available at www.sciencedirect.com/science (lastaccessed Jan. 8, 2019). The surgical visualization system 500 can alsodetermine proximity to various structures within the anatomical field,including the surface of tissue, as further described herein.

In various aspect of the present disclosure, the surface mappingsubsystem can be achieved with a light pattern system, as furtherdescribed herein. The use of a light pattern (or structured light) forsurface mapping is known. Known surface mapping techniques can beutilized in the surgical visualization systems described herein.

Structured light is the process of projecting a known pattern (often agrid or horizontal bars) on to a surface. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, disclose a surgical system comprising a light source and aprojector for projecting a light pattern. U.S. Patent ApplicationPublication No. 2017/0055819, titled SET COMPRISING A SURGICALINSTRUMENT, published Mar. 2, 2017, and U.S. Patent ApplicationPublication No. 2017/0251900, titled DEPICTION SYSTEM, published Sep. 7,2017, are incorporated by reference herein in their respectiveentireties.

FIG. 37 illustrates a structured (or patterned) light system 700,according to at least one aspect of the present disclosure. As describedherein, structured light in the form of stripes or lines, for example,can be projected from a light source and/or projector 706 onto thesurface 705 of targeted anatomy to identify the shape and contours ofthe surface 705. A camera 720, which can be similar in various respectsto the imaging device 520 (FIG. 24 ), for example, can be configured todetect the projected pattern of light on the surface 705. The way thatthe projected pattern deforms upon striking the surface 705 allowsvision systems to calculate the depth and surface information of thetargeted anatomy.

In certain instances, invisible (or imperceptible) structured light canbe utilized. The structured light can be used without interfering withother computer vision tasks for which the projected pattern may beconfusing. For example, the frames with the light pattern can beisolated from the frames that are shown (e.g. augmented out). In stillother instances, infrared light or extremely fast frame rates of visiblelight that alternate between two exact opposite patterns can be utilizedto prevent interference. Structured light is further described aten.wikipedia.org/wiki/Structured_light.

Referring again to FIG. 24 , in one aspect, the surgical visualizationsystem 500 includes an emitter 506, which is configured to emit apattern of light, such as stripes, grid lines, and/or dots, to enablethe determination of the topography or landscape of the surface 505 ofthe tissue 503. For example, projected light arrays 530 can be used forthree-dimensional scanning and registration on the surface 505 of thetissue 503. The projected light arrays 530 can be emitted from theemitter 506 located on the surgical device 502 and/or the robotic arm512, 514 and/or the imaging device 520, for example. In one aspect, theprojected light array 530 is employed to determine the shape defined bythe surface 505 of the tissue 503 and/or the motion of the surface 505intraoperatively. The imaging device 520 is configured to detect theprojected light arrays 530 reflected from the surface 505 to determinethe topography of the surface 505 and various distances with respect tothe surface 505. One or more additional and/or alternative surfacemapping techniques may also be employed.

In various aspects of the present disclosure, a tissue identificationsubsystem can be achieved with a spectral imaging system. The spectralimaging system can rely on hyperspectral imaging, multispectral imaging,or selective spectral imaging, for example. Hyperspectral imaging oftissue is further described in U.S. Pat. No. 9,274,047, titled METHODSAND APPARATUS FOR IMAGING OF OCCLUDED OBJECTS, issued Mar. 1, 2016,which is incorporated by reference herein in its entirety.

In various instances, the imaging device 520 is a spectral camera (e.g.a hyperspectral camera, multispectral camera, or selective spectralcamera), which is configured to detect reflected spectral waveforms andgenerate a spectral cube of images based on the molecular response tothe different wavelengths. Spectral imaging is further described herein.

In various instances, hyperspectral imaging technology, can be employedto identify signatures in anatomical structures in order todifferentiate a critical structure from obscurants. Hyperspectralimaging technology may provide a visualization system that can provide away to identify critical structures such as ureters and/or bloodvessels, for example, especially when those structures are obscured byfat, connective tissue, blood, or other organs, for example. The use ofthe difference in reflectance of different wavelengths in the infrared(IR) spectrum may be employed to determine the presence of keystructures versus obscurants. Referring now to FIGS. 38-40 ,illustrative hyperspectral signatures for a ureter, an artery, and nervetissue with respect to obscurants such as fat, lung tissue, and blood,for example, are depicted.

FIG. 38 is a graphical representation 950 of an illustrative uretersignature versus obscurants. The plots represent reflectance as afunction of wavelength (nm) for wavelengths for fat, lung tissue, blood,and a ureter. FIG. 39 is a graphical representation 952 of anillustrative artery signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a vessel. FIG. 40 is a graphical representation 954 of anillustrative nerve signature versus obscurants. The plots representreflectance as a function of wavelength (nm) for fat, lung tissue,blood, and a nerve.

Referring again to FIG. 24 , the imaging device 520 may include anoptical waveform emitter 523 that is configured to emit electromagneticradiation 524 (NIR photons) that can penetrate the surface 505 of thetissue 503 and reach the critical structures 501 a, 501 b. The imagingdevice 520 and the optical waveform emitter 523 thereon can bepositionable by the robotic arm 512, 514. A corresponding waveformsensor 522 (an image sensor, spectrometer, or vibrational sensor, forexample) on the imaging device 520 is configured to detect the effect ofthe electromagnetic radiation 524 received by the waveform sensor 522.The wavelengths of the electromagnetic radiation 524 emitted by theoptical waveform emitter 523 can be configured to enable theidentification of the type of anatomical and/or physical structure, suchas the critical structures 501 a, 501 b. In one aspect, the wavelengthsof the electromagnetic radiation 524 may be variable. The waveformsensor 522 and optical waveform emitter 523 may be inclusive of amultispectral imaging system and/or a selective spectral imaging system,for example.

The identification of the critical structures 501 a, 501 b can beaccomplished through spectral analysis, photo-acoustics, and/orultrasound, for example. In certain instances, the waveform sensor 522and optical waveform emitter 523 may be inclusive of a photoacousticimaging system, for example. In various instances, the optical waveformemitter 523 can be positioned on a separate surgical device from theimaging device 520. Alternative tissue identification techniques arealso contemplated. In certain instances, the surgical visualizationsystem 500 may not be configured to identify hidden critical structures.

In one instance, the surgical visualization system 500 incorporatestissue identification and geometric surface mapping in combination witha distance determining subsystems, such as the distance sensor system504. The distance sensor system 504 is configured to determine one ormore distances at the surgical site. The distance sensor system 504 is atime-of-flight system that is configured to determine the distance toone or more anatomical structures. Alternative distance determiningsubsystems are also contemplated. In combination, the tissueidentification systems, geometric surface mapping, and the distancedetermining subsystem can determine a position of the criticalstructures 501 a, 501 b within the anatomical field and/or the proximityof a surgical device 502 to the surface 505 of the visible tissue 503and/or to the critical structures 501 a, 501 b.

In various aspects of the present disclosure, the distance determiningsystem can be incorporated into the surface mapping system. For example,structured light can be utilized to generate a three-dimensional virtualmodel of the visible surface and determine various distances withrespect to the visible surface. In other instances, a time-of-flightemitter can be separate from the structured light emitter.

In various instances, the distance determining subsystem can rely ontime-of-flight measurements to determine one or more distances to theidentified tissue (or other structures) at the surgical site. In oneaspect, the distance sensor system 504 may be a time-of-flight distancesensor system that includes an emitter, such as the emitter 506, and areceiver 508, which can be positioned on the surgical device 502. In onegeneral aspect, the emitter 506 of the distance sensor system 504 mayinclude a very tiny laser source and the receiver 508 of the distancesensor system 504 may include a matching sensor. The distance sensorsystem 504 can detect the “time of flight,” or how long the laser lightemitted by the emitter 506 has taken to bounce back to the sensorportion of the receiver 508. Use of a very narrow light source in theemitter 506 can enable the distance sensor system 504 to determine thedistance to the surface 505 of the tissue 503 directly in front of thedistance sensor system 504.

Referring still to FIG. 24 , d_(e) is the emitter-to-tissue distancefrom the emitter 506 to the surface 505 of the tissue 503 and d_(t) isthe device-to-tissue distance from the distal end of the surgical device502 to the surface 505 of the tissue. The distance sensor system 504 canbe employed to determine the emitter-to-tissue distance d_(e). Thedevice-to-tissue distance d_(t) is obtainable from the known position ofthe emitter 506 on the shaft of the surgical device 502 relative to thedistal end of the surgical device 502. In other words, when the distancebetween the emitter 506 and the distal end of the surgical device 502 isknown, the device-to-tissue distance d_(t) can be determined from theemitter-to-tissue distance d_(e).

In various instances, the receiver 508 for the distance sensor system504 can be mounted on a separate surgical device instead of the surgicaldevice 502. For example, the receiver 508 can be mounted on a cannula ortrocar through which the surgical device 502 extends to reach thesurgical site. In still other instances, the receiver 508 for thedistance sensor system 504 can be mounted on a separaterobotically-controlled arm (e.g. the robotic arm 512, 514), on a movablearm that is operated by another robot, and/or to an operating room (OR)table or fixture. In certain instances, the imaging device 520 includesthe time-of-flight receiver 508 to determine the distance from theemitter 506 to the surface 505 of the tissue 503 using a line betweenthe emitter 506 on the surgical device 502 and the imaging device 520.For example, the distance d_(e) can be triangulated based on knownpositions of the emitter 506 (e.g., on the surgical device 502) and thereceiver 508 (e.g. on the imaging device 520) of the distance sensorsystem 504. The three-dimensional position of the receiver 508 can beknown and/or registered to the robot coordinate plane intraoperatively.

In certain instances, the position of the emitter 506 of the distancesensor system 504 can be controlled by the first robotic arm 512 and theposition of the receiver 508 of the distance sensor system 504 can becontrolled by the second robotic arm 514. In other instances, thesurgical visualization system 500 can be utilized apart from a roboticsystem. In such instances, the distance sensor system 504 can beindependent of the robotic system.

In certain instances, one or more of the robotic arms 512, 514 may beseparate from a main robotic system used in the surgical procedure. Atleast one of the robotic arms 512, 514 can be positioned and registeredto a particular coordinate system without servomotor control. Forexample, a closed-loop control system and/or a plurality of sensors forthe robotic arms 512, 514 can control and/or register the position ofthe robotic arm(s) 512, 514 relative to the particular coordinatesystem. Similarly, the position of the surgical device 502 and theimaging device 520 can be registered relative to a particular coordinatesystem.

Referring still to FIG. 24 , d_(w) is the camera-to-critical structuredistance from the optical waveform emitter 523 located on the imagingdevice 520 to the surface of the critical structure 501 a, and d_(A) isthe depth of the critical structure 501 b below the surface 505 of thetissue 503 (i.e., the distance between the portion of the surface 505closest to the surgical device 502 and the critical structure 501 b). Invarious aspects, the time-of-flight of the optical waveforms emittedfrom the optical waveform emitter 523 located on the imaging device 520can be configured to determine the camera-to-critical structure distanced_(w). The use of spectral imaging in combination with time-of-flightsensors is further described herein.

In one aspect, the surgical visualization system 500 is configured todetermine an emitter-to-tissue distance d_(e) from an emitter 506 on thesurgical device 502 to a surface 505 of the uterus via structured light.The surgical visualization system 500 is configured to extrapolate adevice-to-tissue distance d_(t) from the surgical device 502 to thesurface 505 of the uterus based on the emitter-to-tissue distance d_(e).The surgical visualization system 500 is also configured to determine atissue-to-ureter distance d_(A) from the critical structure (the ureter)501 a to the surface 505 and a camera-to ureter distance d_(w) from theimaging device 520 to the critical structure (the ureter) 501 a. Asdescribed herein, the surgical visualization system 500 can determinethe distance d_(w) with spectral imaging and time-of-flight sensors, forexample. In various instances, the surgical visualization system 500 candetermine (e.g. triangulate) the tissue-to-ureter distance d_(A) (ordepth) based on other distances and/or the surface mapping logicdescribed herein.

Referring now to FIG. 29 , in various aspects of the present disclosure,in a surgical visualization system 800, the depth d_(A) of a criticalstructure 801 relative to a surface 805 of a tissue 803 can bedetermined by triangulating from the distance d_(w) and known positionsof an emitter 806 and an optical waveform emitter 823 and detector 823(and, thus, the known distance d_(x) therebetween) to determine thedistance d_(y), which is the sum of the distance d_(e) and the depthd_(A).

Additionally or alternatively, time-of-flight from the optical waveformemitter 823 can be configured to determine the distance from the opticalwaveform emitter 823 to the surface 805 of the tissue 803. For example,a first waveform (or range of waveforms) can be utilized to determinethe camera-to-critical structure distance d_(w) and a second waveform(or range of waveforms) can be utilized to determine the distance to thesurface 805 of the tissue 803. In such instances, the differentwaveforms can be utilized to determine the depth of the criticalstructure 801 below the surface 805 of the tissue 803. Spectraltime-of-flight systems are further described herein.

Additionally or alternatively, in certain instances, the distance d_(A)can be determined from an ultrasound, a registered magnetic resonanceimaging (MRI) or computerized tomography (CT) scan. In still otherinstances, the distance d_(A) can be determined with spectral imagingbecause the detection signal received by the imaging device can varybased on the type of material. For example, fat can decrease thedetection signal in a first way, or a first amount, and collagen candecrease the detection signal in a different, second way, or a secondamount.

Referring now to a surgical visualization system 860 in FIG. 30 , inwhich a surgical device 862 includes the optical waveform emitter 823′and the waveform sensor 822′ that is configured to detect the reflectedwaveforms. The optical waveform emitter 823′ can be configured to emitwaveforms for determining the distances d_(t) and d_(w) from a commondevice, such as the surgical device 862, as further described herein. Insuch instances, the distance d_(A) from the surface 805 of the tissue803 to the surface of the critical structure 801 can be determined asfollows:d _(A) =d _(w) −d _(t).

As disclosed herein, various information regarding visible tissue,embedded critical structures, and surgical devices can be determined byutilizing a combination approach that incorporates one or moretime-of-flight distance sensors, spectral imaging, and/or structuredlight arrays in combination with an image sensor configured to detectthe spectral wavelengths and the structured light arrays. Moreover, animage sensor can be configured to receive visible light and, thus,provide images of the surgical site to an imaging system. Logic oralgorithms are employed to discern the information received from thetime-of-flight sensors, spectral wavelengths, structured light, andvisible light and render three-dimensional images of the surface tissueand underlying anatomical structures. In various instances, the imagingdevice 520 can include multiple image sensors.

The camera-to-critical structure distance d_(w) can also be detected inone or more alternative ways. In one aspect, a fluoroscopy visualizationtechnology, such as fluorescent indosciedine green (ICG), for example,can be utilized to illuminate a critical structure 3201, as shown inFIGS. 31-33 . A camera 3220 can include two optical waveforms sensors3222, 3224, which take simultaneous left-side and right-side images ofthe critical structure 3201 (FIGS. 32A and 32B). In such instances, thecamera 3220 can depict a glow of the critical structure 3201 below thesurface 3205 of the tissue 3203, and the distance d_(w) can bedetermined by the known distance between the sensors 3222 and 3224. Incertain instances, distances can be determined more accurately byutilizing more than one camera or by moving a camera between multiplelocations. In certain aspects, one camera can be controlled by a firstrobotic arm and a second camera by another robotic arm. In such arobotic system, one camera can be a follower camera on a follower arm,for example. The follower arm, and camera thereon, can be programmed totrack the other camera and to maintain a particular distance and/or lensangle, for example.

In still other aspects, the surgical visualization system 500 may employtwo separate waveform receivers (i.e. cameras/image sensors) todetermine d_(w). Referring now to FIG. 34 , if a critical structure 3301or the contents thereof (e.g. a vessel or the contents of the vessel)can emit a signal 3302, such as with fluoroscopy, then the actuallocation can be triangulated from two separate cameras 3320 a, 3320 b atknown locations.

In another aspect, referring now to FIGS. 35A and 35B, a surgicalvisualization system may employ a dithering or moving camera 440 todetermine the distance d_(w). The camera 440 is robotically-controlledsuch that the three-dimensional coordinates of the camera 440 at thedifferent positions are known. In various instances, the camera 440 canpivot at a cannula or patient interface. For example, if a criticalstructure 401 or the contents thereof (e.g. a vessel or the contents ofthe vessel) can emit a signal, such as with fluoroscopy, for example,then the actual location can be triangulated from the camera 440 movedrapidly between two or more known locations. In FIG. 35A, the camera 440is moved axially along an axis A. More specifically, the camera 440translates a distance d₁ closer to the critical structure 401 along theaxis A to the location indicated as a location 440′, such as by movingin and out on a robotic arm. As the camera 440 moves the distance d₁ andthe size of view change with respect to the critical structure 401, thedistance to the critical structure 401 can be calculated. For example, a4.28 mm axial translation (the distance d₁) can correspond to an angleθ₁ of 6.28 degrees and an angle θ₂ of 8.19 degrees.

Additionally or alternatively, the camera 440 can rotate or sweep alongan arc between different positions. Referring now to FIG. 35B, thecamera 440 is moved axially along the axis A and is rotated an angle θ₃about the axis A. A pivot point 442 for rotation of the camera 440 ispositioned at the cannula/patient interface. In FIG. 35B, the camera 440is translated and rotated to a location 440″. As the camera 440 movesand the edge of view changes with respect to the critical structure 401,the distance to the critical structure 401 can be calculated. In FIG.35B, a distance d₂ can be 9.01 mm, for example, and the angle θ₃ can be0.9 degrees, for example.

FIG. 25 is a schematic diagram of the control system 833, which can beutilized with the surgical visualization system 500 and the inputcontrol device 1000, for example. The control system 833 includes acontrol circuit 832 in signal communication with a memory 834. Thememory 834 stores instructions executable by the control circuit 832 todetermine and/or recognize critical structures (e.g. the criticalstructures 501 a, 501 b in FIG. 24 ), determine and/or compute one ormore distances and/or three-dimensional digital representations, and/orto communicate certain information to one or more clinicians, amongother things. For example, the memory 834 stores surface mapping logic836, imaging logic 838, tissue identification logic 840, or distancedetermining logic 841 or any combinations of the logic 836, 838, 840,and 841. The memory 834 can also include input control device logic forimplementing the input controls provided to the input control device1000, including scaling and/or locking out certain controls in certaincircumstances and/or switching between operational modes based onreal-time, intraoperative tissue proximity data, for example. Thecontrol system 833 also includes an imaging system 842 having one ormore cameras 844 (like the imaging device 520 in FIG. 24 ), one or moredisplays 846, or one or more controls 848 or any combinations of theseelements. The camera 844 can include one or more image sensors 835 toreceive signals from various light sources emitting light at variousvisible and invisible spectra (e.g. visible light, spectral imagers,three-dimensional lens, among others). The display 846 can include oneor more screens or monitors for depicting real, virtual, and/orvirtually-augmented images and/or information to one or more clinicians.

In various aspects, the heart of the camera 844 is the image sensor 835.Generally, modern image sensors 835 are solid-state electronic devicescontaining up to millions of discrete photodetector sites called pixels.The image sensor 835 technology falls into one of two categories:Charge-Coupled Device (CCD) and Complementary Metal Oxide Semiconductor(CMOS) imagers and more recently, short-wave infrared (SWIR) is anemerging technology in imaging. Another type of image sensor 835 employsa hybrid CCD/CMOS architecture (sold under the name “sCMOS”) andconsists of CMOS readout integrated circuits (ROICs) that are bumpbonded to a CCD imaging substrate. CCD and CMOS image sensors 835 aresensitive to wavelengths from approximately 350-1050 nm, although therange is usually given from 400-1000 nm. CMOS sensors are, in general,more sensitive to IR wavelengths than CCD sensors. Solid state imagesensors 835 are based on the photoelectric effect and, as a result,cannot distinguish between colors. Accordingly, there are two types ofcolor CCD cameras: single chip and three-chip. Single chip color CCDcameras offer a common, low-cost imaging solution and use a mosaic (e.g.Bayer) optical filter to separate incoming light into a series of colorsand employ an interpolation algorithm to resolve full color images. Eachcolor is, then, directed to a different set of pixels. Three-chip colorCCD cameras provide higher resolution by employing a prism to directeach section of the incident spectrum to a different chip. More accuratecolor reproduction is possible, as each point in space of the object hasseparate RGB intensity values, rather than using an algorithm todetermine the color. Three-chip cameras offer extremely highresolutions.

The control system 833 also includes a spectral light source 850 and astructured light source 852. In certain instances, a single source canbe pulsed to emit wavelengths of light in the spectral light source 850range and wavelengths of light in the structured light source 852 range.Alternatively, a single light source can be pulsed to provide light inthe invisible spectrum (e.g. infrared spectral light) and wavelengths oflight on the visible spectrum. The spectral light source 850 can be ahyperspectral light source, a multispectral light source, and/or aselective spectral light source, for example. In various instances, thetissue identification logic 840 can identify critical structure(s) viadata from the spectral light source 850 received by the image sensor 835portion of the camera 844. The surface mapping logic 836 can determinethe surface contours of the visible tissue based on reflected structuredlight. With time-of-flight measurements, the distance determining logic841 can determine one or more distance(s) to the visible tissue and/or acritical structure. One or more outputs from the surface mapping logic836, the tissue identification logic 840, and the distance determininglogic 841, can be provided to the imaging logic 838, and combined,blended, and/or overlaid to be conveyed to a clinician via the display846 of the imaging system 842.

The description now turns briefly to FIGS. 26-28 to describe variousaspects of the control circuit 832 for controlling various aspects ofthe surgical visualization system 500. Turning to FIG. 26 , there isillustrated a control circuit 400 configured to control aspects of thesurgical visualization system 500, according to at least one aspect ofthis disclosure. The control circuit 400 can be configured to implementvarious processes described herein. The control circuit 400 may comprisea microcontroller comprising one or more processors 402 (e.g.,microprocessor, microcontroller) coupled to at least one memory circuit404. The memory circuit 404 stores machine-executable instructions that,when executed by the processor 402, cause the processor 402 to executemachine instructions to implement various processes described herein.The processor 402 may be any one of a number of single-core or multicoreprocessors known in the art. The memory circuit 404 may comprisevolatile and non-volatile storage media. The processor 402 may includean instruction processing unit 406 and an arithmetic unit 408. Theinstruction processing unit may be configured to receive instructionsfrom the memory circuit 404 of this disclosure.

FIG. 27 illustrates a combinational logic circuit 410 configured tocontrol aspects of the surgical visualization system 500, according toat least one aspect of this disclosure. The combinational logic circuit410 can be configured to implement various processes described herein.The combinational logic circuit 410 may comprise a finite state machinecomprising a combinational logic 412 configured to receive dataassociated with the surgical instrument or tool at an input 414, processthe data by the combinational logic 412, and provide an output 416.

FIG. 28 illustrates a sequential logic circuit 420 configured to controlaspects of the surgical visualization system 500, according to at leastone aspect of this disclosure. The sequential logic circuit 420 or thecombinational logic 422 can be configured to implement various processesdescribed herein. The sequential logic circuit 420 may comprise a finitestate machine. The sequential logic circuit 420 may comprise acombinational logic 422, at least one memory circuit 424, and a clock429, for example. The at least one memory circuit 424 can store acurrent state of the finite state machine. In certain instances, thesequential logic circuit 420 may be synchronous or asynchronous. Thecombinational logic 422 is configured to receive data associated with asurgical device or system from an input 426, process the data by thecombinational logic 422, and provide an output 428. In other aspects,the circuit may comprise a combination of a processor (e.g., processor402 in FIG. 26 ) and a finite state machine to implement variousprocesses herein. In other aspects, the finite state machine maycomprise a combination of a combinational logic circuit (e.g.,combinational logic circuit 410, FIG. 27 ) and the sequential logiccircuit 420.

Referring now to FIG. 36 , where a schematic of a control system 600 fora surgical visualization system, such as the surgical visualizationsystem 500, for example, is depicted. The control system 600 is aconversion system that integrates spectral signature tissueidentification and structured light tissue positioning to identifycritical structures, especially when those structures are obscured byother tissue, such as fat, connective tissue, blood, and/or otherorgans, for example. Such technology could also be useful for detectingtissue variability, such as differentiating tumors and/or non-healthytissue from healthy tissue within an organ.

The control system 600 is configured for implementing a hyperspectralimaging and visualization system in which a molecular response isutilized to detect and identify anatomy in a surgical field of view. Thecontrol system 600 includes a conversion logic circuit 648 to converttissue data to surgeon usable information. For example, the variablereflectance based on wavelengths with respect to obscuring material canbe utilized to identify the critical structure in the anatomy. Moreover,the control system 600 combines the identified spectral signature andthe structural light data in an image. For example, the control system600 can be employed to create of three-dimensional data set for surgicaluse in a system with augmentation image overlays. Techniques can beemployed both intraoperatively and preoperatively using additionalvisual information. In various instances, the control system 600 isconfigured to provide warnings to a clinician when in the proximity ofone or more critical structures. Various algorithms can be employed toguide robotic automation and semi-automated approaches based on thesurgical procedure and proximity to the critical structure(s).

A projected array of lights is employed to determine tissue shape andmotion intraoperatively. Alternatively, flash Lidar may be utilized forsurface mapping of the tissue.

The control system 600 is configured to detect the critical structure(s)and provide an image overlay of the critical structure and measure thedistance to the surface of the visible tissue and the distance to theembedded/buried critical structure(s). In other instances, the controlsystem 600 can measure the distance to the surface of the visible tissueor detect the critical structure(s) and provide an image overlay of thecritical structure.

The control system 600 includes a spectral control circuit 602. Thespectral control circuit 602 can be a field programmable gate array(FPGA) or another suitable circuit configuration as described herein inconnection with FIGS. 26-28 , for example. The spectral control circuit602 includes a processor 604 to receive video input signals from a videoinput processor 606. The processor 604 can be configured forhyperspectral processing and can utilize C/C++ code, for example. Thevideo input processor 606 receives video-in of control (metadata) datasuch as shutter time, wavelength, and sensor analytics, for example. Theprocessor 604 is configured to process the video input signal from thevideo input processor 606 and provide a video output signal to a videooutput processor 608, which includes a hyperspectral video-out ofinterface control (metadata) data, for example. The video outputprocessor 608 provides the video output signal to an image overlaycontroller 610.

The video input processor 606 is coupled to a camera 612 at the patientside via a patient isolation circuit 614. As previously discussed, thecamera 612 includes a solid state image sensor 634. The patientisolation circuit can include a plurality of transformers so that thepatient is isolated from other circuits in the system. The camera 612receives intraoperative images through optics 632 and the image sensor634. The image sensor 634 can include a CMOS image sensor, for example,or may include any of the image sensor technologies discussed herein inconnection with FIG. 25 , for example. In one aspect, the camera 612outputs images in 14 bit/pixel signals. It will be appreciated thathigher or lower pixel resolutions may be employed without departing fromthe scope of the present disclosure. The isolated camera output signal613 is provided to a color RGB fusion circuit 616, which employs ahardware register 618 and a Nios2 co-processor 620 to process the cameraoutput signal 613. A color RGB fusion output signal is provided to thevideo input processor 606 and a laser pulsing control circuit 622.

The laser pulsing control circuit 622 controls a laser light engine 624.The laser light engine 624 outputs light in a plurality of wavelengths(λ₁, λ₂, λ₃ . . . λ_(n)) including near infrared (NIR). The laser lightengine 624 can operate in a plurality of modes. In one aspect, the laserlight engine 624 can operate in two modes, for example. In a first mode,e.g. a normal operating mode, the laser light engine 624 outputs anilluminating signal. In a second mode, e.g. an identification mode, thelaser light engine 624 outputs RGBG and NIR light. In various instances,the laser light engine 624 can operate in a polarizing mode.

Light output 626 from the laser light engine 624 illuminates targetedanatomy in an intraoperative surgical site 627. The laser pulsingcontrol circuit 622 also controls a laser pulse controller 628 for alaser pattern projector 630 that projects a laser light pattern 631,such as a grid or pattern of lines and/or dots, at a predeterminedwavelength (A) on the operative tissue or organ at the surgical site627. The camera 612 receives the patterned light as well as thereflected light output through the camera optics 632. The image sensor634 converts the received light into a digital signal.

The color RGB fusion circuit 616 also outputs signals to the imageoverlay controller 610 and a video input module 636 for reading thelaser light pattern 631 projected onto the targeted anatomy at thesurgical site 627 by the laser pattern projector 630. A processingmodule 638 processes the laser light pattern 631 and outputs a firstvideo output signal 640 representative of the distance to the visibletissue at the surgical site 627. The data is provided to the imageoverlay controller 610. The processing module 638 also outputs a secondvideo signal 642 representative of a three-dimensional rendered shape ofthe tissue or organ of the targeted anatomy at the surgical site.

The first and second video output signals 640, 642 include datarepresentative of the position of the critical structure on athree-dimensional surface model, which is provided to an integrationmodule 643. In combination with data from the video out processor 608 ofthe spectral control circuit 602, the integration module 643 candetermine the distance d_(A) (FIG. 24 ) to a buried critical structure(e.g. via triangularization algorithms 644), and the distance d_(A) canbe provided to the image overlay controller 610 via a video outprocessor 646. The foregoing conversion logic can encompass theconversion logic circuit 648 intermediate video monitors 652 and thecamera 612, the laser light engine 624, and laser pattern projector 630positioned at the surgical site 627.

Preoperative data 650 from a CT or MRI scan can be employed to registeror align certain three-dimensional deformable tissue in variousinstances. Such preoperative data 650 can be provided to the integrationmodule 643 and ultimately to the image overlay controller 610 so thatsuch information can be overlaid with the views from the camera 612 andprovided to the video monitors 652. Registration of preoperative data isfurther described herein and in U.S. patent application Ser. No.16/128,195, titled INTEGRATION OF IMAGING DATA, filed Sep. 11, 2018, forexample, which is incorporated by reference herein in its entirety.

The video monitors 652 can output the integrated/augmented views fromthe image overlay controller 610. A clinician can select and/or togglebetween different views on one or more monitors. On a first monitor 652a, the clinician can toggle between (A) a view in which athree-dimensional rendering of the visible tissue is depicted and (B) anaugmented view in which one or more hidden critical structures aredepicted over the three-dimensional rendering of the visible tissue. Ona second monitor 652 b, the clinician can toggle on distancemeasurements to one or more hidden critical structures and/or thesurface of visible tissue, for example.

The control system 600 and/or various control circuits thereof can beincorporated into various surgical visualization systems disclosedherein.

In various instances, select wavelengths for spectral imaging can beidentified and utilized based on the anticipated critical structuresand/or obscurants at a surgical site (i.e. “selective spectral”imaging). By utilizing selective spectral imaging, the amount of timerequired to obtain the spectral image can be minimized such that theinformation can be obtained in real-time, or near real-time, andutilized intraoperatively. In various instances, the wavelengths can beselected by a clinician or by a control circuit based on input by theclinician. In certain instances, the wavelengths can be selected basedon machine learning and/or big data accessible to the control circuitvia a cloud, for example.

The foregoing application of spectral imaging to tissue can be utilizedintraoperatively to measure the distance between a waveform emitter anda critical structure that is obscured by tissue. In one aspect of thepresent disclosure, referring now to FIGS. 41 and 42 , a time-of-flightsensor system 2104 utilizing waveforms 2124, 2125 is shown. Thetime-of-flight sensor system 2104 can be incorporated into the surgicalvisualization system 500 (FIG. 24 ) in certain instances. Thetime-of-flight sensor system 2104 includes a waveform emitter 2106 and awaveform receiver 2108 on the same surgical device 2102. The emittedwave 2124 extends to the critical structure 2101 from the emitter 2106and the received wave 2125 is reflected back to the receiver 2108 fromthe critical structure 2101. The surgical device 2102 is positionedthrough a trocar 2110 that extends into a cavity 2107 in a patient.

The waveforms 2124, 2125 are configured to penetrate obscuring tissue2103. For example, the wavelengths of the waveforms 2124, 2125 can be inthe NIR or SWIR spectrum of wavelengths. In one aspect, a spectralsignal (e.g. hyperspectral, multispectral, or selective spectral) or aphotoacoustic signal can be emitted from the emitter 2106 and canpenetrate the tissue 2103 in which the critical structure 2101 isconcealed. The emitted waveform 2124 can be reflected by the criticalstructure 2101. The received waveform 2125 can be delayed due to thedistance d between the distal end of the surgical device 2102 and thecritical structure 2101. In various instances, the waveforms 2124, 2125can be selected to target the critical structure 2101 within the tissue2103 based on the spectral signature of the critical structure 2101, asfurther described herein. In various instances, the emitter 2106 isconfigured to provide a binary signal on and off, as shown in FIG. 42 ,for example, which can be measured by the receiver 2108.

Based on the delay between the emitted wave 2124 and the received wave2125, the time-of-flight sensor system 2104 is configured to determinethe distance d (FIG. 41 ). A time-of-flight timing diagram 2130 for theemitter 2106 and the receiver 2108 of FIG. 41 is shown in FIG. 42 . Thedelay is a function of the distance d and the distance d is given by:

$d = {\frac{ct}{2} \cdot \frac{q_{2}}{q_{1} + q_{2}}}$where:

c=the speed of light;

t=length of pulse;

q₁=accumulated charge while light is emitted; and

q₂=accumulated charge while light is not being emitted.

As provided herein, the time-of-flight of the waveforms 2124, 2125corresponds to the distance d in FIG. 41 . In various instances,additional emitters/receivers and/or pulsing signals from the emitter2106 can be configured to emit a non-penetrating signal. Thenon-penetrating tissue can be configured to determine the distance fromthe emitter to the surface 2105 of the obscuring tissue 2103. In variousinstances, the depth of the critical structure 2101 can be determinedby:d _(A) =d _(w) −d _(t).where:

d_(A)=the depth of the critical structure 2101 below the surface 2105 ofthe obscuring tissue 2103;

d_(w)=the distance from the emitter 2106 to the critical structure 2101(d in FIG. 41 ); and

d_(t),=the distance from the emitter 2106 (on the distal end of thesurgical device 2102) to the surface 2105 of the obscuring tissue 2103.

In one aspect of the present disclosure, referring now to FIG. 43 , atime-of-flight sensor system 2204 utilizing waves 2224 a, 2224 b, 2224c, 2225 a, 2225 b, 2225 c is shown. The time-of-flight sensor system2204 can be incorporated into the surgical visualization system 500(FIG. 24 ) in certain instances. The time-of-flight sensor system 2204includes a waveform emitter 2206 and a waveform receiver 2208. Thewaveform emitter 2206 is positioned on a first surgical device 2202 a,and the waveform receiver 2208 is positioned on a second surgical device2202 b. The surgical devices 2202 a, 2202 b are positioned through theirrespective trocars 2210 a, 2210 b, respectively, which extend into acavity 2207 in a patient. The emitted waves 2224 a, 2224 b, 2224 cextend toward a surgical site from the emitter 2206 and the receivedwaves 2225 a, 2225 b, 2225 c are reflected back to the receiver 2208from various structures and/or surfaces at the surgical site.

The different emitted waves 2224 a, 2224 b, 2224 c are configured totarget different types of material at the surgical site. For example,the wave 2224 a targets the obscuring tissue 2203, the wave 2224 btargets a first critical structure 2201 a (e.g. a vessel), and the wave2224 c targets a second critical structure 2201 b (e.g. a canceroustumor). The wavelengths of the waves 2224 a, 2224 b, 2224 c can be inthe visible light, NIR, or SWIR spectrum of wavelengths. For example,visible light can be reflected off a surface 2205 of the tissue 2203 andNIR and/or SWIR waveforms can be configured to penetrate the surface2205 of the tissue 2203. In various aspects, as described herein, aspectral signal (e.g. hyperspectral, multispectral, or selectivespectral) or a photoacoustic signal can be emitted from the emitter2206. In various instances, the waves 2224 b, 2224 c can be selected totarget the critical structures 2201 a, 2201 b within the tissue 2203based on the spectral signature of the critical structures 2201 a, 2201b, as further described herein.

The emitted waves 2224 a, 2224 b, 2224 c can be reflected off thetargeted material (i.e. the surface 2205, the first critical structure2201 a, and the second structure 2201 b, respectively). The receivedwaveforms 2225 a, 2225 b, 2225 c can be delayed due to the distancesd_(1a), d_(2a), d_(3a), d_(1b), d_(2b), d_(3b) indicated in FIG. 43 .

In the time-of-flight sensor system 2204, in which the emitter 2206 andthe receiver 2208 are independently positionable (e.g., on separatesurgical devices 2202 a, 2202 b and/or controlled by separate roboticarms), the various distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(3b) can be calculated from the known position of the emitter 2206 andthe receiver 2208. For example, the positions can be known when thesurgical devices 2202 a, 2202 b are robotically-controlled. Knowledge ofthe positions of the emitter 2206 and the receiver 2208, as well as thetime of the photon stream to target a certain tissue and the informationreceived by the receiver 2208 of that particular response can allow adetermination of the distances d_(1a), d_(2a), d_(3a), d_(1b), d_(2b),d_(3b). In one aspect, the distance to the obscured critical structures2201 a, 2201 b can be triangulated using penetrating wavelengths.Because the speed of light is constant for any wavelength of visible orinvisible light, the time-of-flight sensor system 2204 can determine thevarious distances.

Referring still to FIG. 43 , in various instances, in the view providedto the clinician, the receiver 2208 can be rotated such that the centerof mass of the target structure in the resulting images remainsconstant, i.e., in a plane perpendicular to the axis of a select targetstructures 2203, 2201 a, or 2201 b. Such an orientation can quicklycommunicate one or more relevant distances and/or perspectives withrespect to the critical structure. For example, as shown in FIG. 43 ,the surgical site is displayed from a viewpoint in which the firstcritical structure 2201 a is perpendicular to the viewing plane (i.e.the vessel is oriented in/out of the page). In various instances, suchan orientation can be the default setting; however, the view can berotated or otherwise adjusted by a clinician. In certain instances, theclinician can toggle between different surfaces and/or target structuresthat define the viewpoint of the surgical site provided by the imagingsystem.

In various instances, the receiver 2208 can be mounted on a trocar orcannula, such as the trocar 2210 b, for example, through which thesecond surgical device 2202 b is positioned. In other instances, thereceiver 2208 can be mounted on a separate robotic arm for which thethree-dimensional position is known. In various instances, the receiver2208 can be mounted on a movable arm that is separate from the robotthat controls the first surgical device 2202 a or can be mounted to anoperating room (OR) table that is intraoperatively registerable to therobot coordinate plane. In such instances, the position of the emitter2206 and the receiver 2208 can be registerable to the same coordinateplane such that the distances can be triangulated from outputs from thetime-of-flight sensor system 2204.

Combining time-of-flight sensor systems and near-infrared spectroscopy(NIRS), termed TOF-NIRS, which is capable of measuring the time-resolvedprofiles of NIR light with nanosecond resolution can be found in thearticle titled TIME-OF-FLIGHT NEAR-INFRARED SPECTROSCOPY FORNONDESTRUCTIVE MEASUREMENT OF INTERNAL QUALITY IN GRAPEFRUIT, in theJournal of the American Society for Horticultural Science, May 2013 vol.138 no. 3 225-228, which is incorporated by reference herein in itsentirety, and is accessible atjournal.ashspublications.org/content/138/3/225.full.

In various instances, time-of-flight spectral waveforms are configuredto determine the depth of the critical structure and/or the proximity ofa surgical device to the critical structure. Moreover, the varioussurgical visualization systems disclosed herein include surface mappinglogic that is configured to create three-dimensional rendering of thesurface of the visible tissue. In such instances, even when the visibletissue obstructs a critical structure, the clinician can be aware of theproximity (or lack thereof) of a surgical device to the criticalstructure. In one instance, the topography of the surgical site isprovided on a monitor by the surface mapping logic. If the criticalstructure is close to the surface of the tissue, spectral imaging canconvey the position of the critical structure to the clinician. Forexample, spectral imaging may detect structures within 5 or 10 mm of thesurface. In other instances, spectral imaging may detect structures 10or 20 mm below the surface of the tissue. Based on the known limits ofthe spectral imaging system, the system is configured to convey that acritical structure is out-of-range if it is simply not detected by thespectral imaging system. Therefore, the clinician can continue to movethe surgical device and/or manipulate the tissue. When the criticalstructure moves into range of the spectral imaging system, the systemcan identify the structure and, thus, communicate that the structure iswithin range. In such instances, an alert can be provided when astructure is initially identified and/or moved further within apredefined proximity zone. In such instances, even non-identification ofa critical structure by a spectral imaging system with knownbounds/ranges can provide proximity information (i.e. the lack ofproximity) to the clinician.

Various surgical visualization systems disclosed herein can beconfigured to identify intraoperatively the presence of and/or proximityto critical structure(s) and to alert a clinician prior to damaging thecritical structure(s) by inadvertent dissection and/or transection. Invarious aspects, the surgical visualization systems are configured toidentify one or more of the following critical structures: ureters,bowel, rectum, nerves (including the phrenic nerve, recurrent laryngealnerve [RLN], promontory facial nerve, vagus nerve, and branchesthereof), vessels (including the pulmonary and lobar arteries and veins,inferior mesenteric artery [IMA] and branches thereof, superior rectalartery, sigmoidal arteries, and left colic artery), superior mesentericartery (SMA) and branches thereof (including middle colic artery, rightcolic artery, ilecolic artery), hepatic artery and branches thereof,portal vein and branches thereof, splenic artery/vein and branchesthereof, external and internal (hypogastric) ileac vessels, shortgastric arteries, uterine arteries, middle sacral vessels, and lymphnodes, for example. Moreover, the surgical visualization systems areconfigured to indicate proximity of surgical device(s) to the criticalstructure(s) and/or warn the clinician when surgical device(s) aregetting close to the critical structure(s).

Various aspects of the present disclosure provide intraoperativecritical structure identification (e.g., identification of ureters,nerves, and/or vessels) and instrument proximity monitoring. Forexample, various surgical visualization systems disclosed herein caninclude spectral imaging and surgical instrument tracking, which enablethe visualization of critical structures below the surface of thetissue, such as 1.0-1.5 cm below the surface of the tissue, for example.In other instances, the surgical visualization system can identifystructures less than 1.0 cm or more the 1.5 cm below the surface of thetissue. For example, even a surgical visualization system that canidentify structures only within 0.2 mm of the surface, for example, canbe valuable if the structure cannot otherwise be seen due to the depth.In various aspects, the surgical visualization system can augment theclinician's view with a virtual depiction of the critical structure as avisible white-light image overlay on the surface of visible tissue, forexample. The surgical visualization system can provide real-time,three-dimensional spatial tracking of the distal tip of surgicalinstruments and can provide a proximity alert when the distal tip of asurgical instrument moves within a certain range of the criticalstructure, such as within 1.0 cm of the critical structure, for example.

Various surgical visualization systems disclosed herein can identifywhen dissection is too close to a critical structure. Dissection may be“too close” to a critical structure based on the temperature (i.e. toohot within a proximity of the critical structure that may riskdamaging/heating/melting the critical structure) and/or based on tension(i.e. too much tension within a proximity of the critical structure thatmay risk damaging/tearing/pulling the critical structure). Such asurgical visualization system can facilitate dissection around vesselswhen skeletonizing the vessels prior to ligation, for example. Invarious instances, a thermal imaging camera can be utilized to read theheat at the surgical site and provide a warning to the clinician that isbased on the detected heat and the distance from a tool to thestructure. For example, if the temperature of the tool is over apredefined threshold (such as 120 degrees F., for example), an alert canbe provided to the clinician at a first distance (such as 10 mm, forexample), and if the temperature of the tool is less than or equal tothe predefined threshold, the alert can be provided to the clinician ata second distance (such as 5 mm, for example). The predefined thresholdsand/or warning distances can be default settings and/or programmable bythe clinician. Additionally or alternatively, a proximity alert can belinked to thermal measurements made by the tool itself, such as athermocouple that measures the heat in a distal jaw of a monopolar orbipolar dissector or vessel sealer, for example.

Various surgical visualization systems disclosed herein can provideadequate sensitivity with respect to a critical structure andspecificity to enable a clinician to proceed with confidence in a quickbut safe dissection based on the standard of care and/or device safetydata. The system can function intraoperatively and in real-time during asurgical procedure with minimal ionizing radiation risk to a patient ora clinician and, in various instances, no risk of ionizing radiationrisk to the patient or the clinician. Conversely, in a fluoroscopyprocedure, the patient and clinician(s) may be exposed to ionizingradiation via an X-ray beam, for example, that is utilized to view theanatomical structures in real-time.

Various surgical visualization system disclosed herein can be configuredto detect and identify one or more desired types of critical structuresin a forward path of a surgical device, such as when the path of thesurgical device is robotically controlled, for example. Additionally oralternatively, the surgical visualization system can be configured todetect and identify one or more types of critical structures in asurrounding area of the surgical device and/or in multipleplanes/dimensions, for example.

Various surgical visualization systems disclosed herein can be easy tooperate and/or interpret. Moreover, various surgical visualizationsystems can incorporate an “override” feature that allows the clinicianto override a default setting and/or operation. For example, a cliniciancan selectively turn off alerts from the surgical visualization systemand/or get closer to a critical structure than suggested by the surgicalvisualization system such as when the risk to the critical structure isless than risk of avoiding the area (e.g. when removing cancer around acritical structure the risk of leaving the cancerous tissue can begreater than the risk of damage to the critical structure).

Various surgical visualization systems disclosed herein can beincorporated into a surgical system and/or used during a surgicalprocedure with limited impact to the workflow. In other words,implementation of the surgical visualization system may not change theway the surgical procedure is implemented. Moreover, the surgicalvisualization system can be economical in comparison to the costs of aninadvertent transection. Data indicates the reduction in inadvertentdamage to a critical structure can drive incremental reimbursement.

Various surgical visualization systems disclosed herein can operate inreal-time, or near real-time, and far enough in advance to enable aclinician to anticipate critical structure(s). For example, a surgicalvisualization system can provide enough time to “slow down, evaluate,and avoid” in order to maximize efficiency of the surgical procedure.

Various surgical visualization systems disclosed herein may not requirea contrast agent, or dye, that is injected into tissue. For example,spectral imaging is configured to visualize hidden structuresintraoperatively without the use of a contrast agent or dye. In otherinstances, the contrast agent can be easier to inject into the properlayer(s) of tissue than other visualization systems. The time betweeninjection of the contrast agent and visualization of the criticalstructure can be less than two hours, for example.

Various surgical visualization systems disclosed herein can be linkedwith clinical data and/or device data. For example, data can provideboundaries for how close energy-enabled surgical devices (or otherpotentially damaging devices) should be from tissue that the surgeondoes not want to damage. Any data modules that interface with thesurgical visualization systems disclosed herein can be providedintegrally or separately from a robot to enable use with stand-alonesurgical devices in open or laparoscopic procedures, for example. Thesurgical visualization systems can be compatible with robotic surgicalsystems in various instances. For example, the visualizationimages/information can be displayed in a robotic console.

Various surgical visualization systems disclosed herein can provideenhanced visualization data and additional information to the surgeon(s)and/or the control unit for a robotic system and/or controller thereforto improve, enhance, and/or inform the input control device and/orcontrols for the robotic system.

Additional Control Systems

Certain surgeons may be accustomed to using handheld surgical instrumentin which a displacement of the handle portion of the surgical instrumenteffects a corresponding displacement of the end effector portion of thesurgical instrument. For example, advancing the handle of a surgicalinstrument one inch can cause the end effector of the surgicalinstrument to be advanced a corresponding one inch. Such one-to-onecorrelations between inputs and outputs can be preferred by certainsurgeons utilizing robotic applications as well. For example, whenmoving a robotic surgical end effector around tissue, one-to-onecorrelations between input motions and output motions can provide anintuitive control motion. Though one-to-one correlations can bedesirable in certain instances, without the assistance of a clutchingmechanism, such input motions may not be feasible or practical whendisplacing a surgical tool across large distances. Moreover, one-to-onecorrelations may not be necessary or desired in certain instances;however, a surgeon can prefer a displacement input motion (translatingand/or rotating) when controlling a robotic surgical tool in certaininstances, such as during a precision motion mode.

A clutchless input control device can allow limited translation of aportion thereof during a precision motion mode and can rely on forcesensing technology, such as the space joint 1006 and the sensorarrangement 1048 (FIGS. 8 and 9 ) during a gross motion mode. Tissueproximity data can toggle the input control device between the precisionmotion mode and the gross motion mode. In such instances, the surgeoncan utilize force sensors to drive a surgical end effector largedistances toward tissue and, upon reaching a predefined proximity to thetissue, can utilize the limited translation of the portion of theclutchless input control device to provide displacement input motions tocontrol the robotic surgical tool.

Referring now to FIGS. 44-49 , an input control device 4000 is shown.The input control device 4000 is a clutchless input control device, asfurther described herein. The input control device 4000 can be utilizedat a surgeon's console or workspace for a robotic surgical system. Forexample, the input control device 4000 can be incorporated into asurgical system, such as the surgical system 110 (FIG. 1 ) or thesurgical system 150 (FIG. 3 ), for example, to provide control signalsto a surgical robot and/or surgical tool coupled thereto. The inputcontrol device 4000 includes manual input controls for moving therobotic arm and/or the surgical tool in three-dimensional space. Forexample, the surgical tool controlled by the input control device 4000can be configured to move in three-dimensional space and rotate orarticulate about multiple axes (e.g. roll about a longitudinal tool axisand articulate about one or more articulation axes).

The input control device 4000 includes a multi-dimensional space joint4006 having a central portion 4002 supported on a base 4004, similar tothe multi-dimensional space joint 1006, the central portion 1002, andthe base 1004 of the input control device 1000 (FIGS. 6-11 ) in manyrespects. For example, the base 4004 is structured to rest on a surface,such as a desk or work surface at a surgeon's console or workspace andcan remain in a fixed, stationary position relative to an underlyingsurface upon application of the input control motions to the inputcontrol device 4000. The space joint 4006 is configured to receivemulti-dimensional inputs corresponding to control motions for thesurgical tool in multi-dimensional space. A power cord 4032 extends fromthe base 4004. The input control device 4000 also include a multi-axisforce and/or torque sensor arrangement 4048 (FIG. 46 ), similar to thesensor arrangement 1048 (FIGS. 8 and 9 ) in many respects. For example,the sensor arrangement 4048 is configured to detect forces and momentsat the space joint 4006, such as forces applied to the central portion4002. Multi-dimensional space joints and sensor arrangements thereforare further described herein.

The central portion 4002 is flexibly supported relative to the base4004. In such instances, the central portion 4002 can be configured tomove or float within a small predefined zone upon receipt of forcecontrol inputs thereto. For example, the central portion 4002 can be afloating shaft that is supported on the base 4004 by one or moreelastomeric members such as springs, for example. The central portion4002 can be configured to move or float within a predefinedthree-dimensional volume. For example, elastomeric couplings can permitmovement of the central portion 4002 relative to the base 4004; however,restraining plates, pins, and/or other structures can be configured tolimit the range of motion of the central portion 4002 relative to thebase 4004. In one aspect, movement of the central portion 4002 from acentral or “home” position relative to the base 4004 can be permittedwithin a range of about 1.0 mm to about 5.0 mm in any direction (up,down, left, right, backwards and forwards). In other instances, movementof the central portion 4002 relative to the base 4004 can be restrainedto less than 1.0 mm or more than 5.0 mm. In certain instances, thecentral portion 4002 can move about 2.0 mm in all directions relative tothe base 4004 and, in still other instances, the central portion 4002can remain stationary or fixed relative to the base 4004.

In various instances, the central portion 4002 of the space joint 4006can be spring-biased toward the central or home position, in which thecentral portion 4002 is aligned with the Z axis, a vertical axis throughthe central portion 4002 and the space joint 4006. Driving (e.g. pushingand/or pulling) the central portion 4002 away from the Z axis in anydirection can be configured to “drive” an end effector of an associatedsurgical tool in the corresponding direction. When the external drivingforce is removed, the central portion 4002 can be configured to returnto the central or home position and motion of the end effector can behalted. Controlling the robotic surgical tool by forces applied to thesensor arrangement 4048 at the space joint 4006 can be permitted duringportions of a surgical procedure, such as during a gross motion mode, asfurther described herein.

In various instances, the space joint 4006 and the central portion 4002coupled thereto define a six degree-of-freedom input control. Referringagain to the end effector 1052 of the surgical tool 1050 in FIG. 12 ,the forces on the central portion 4002 of the input control device 4000in the X direction correspond to displacement of the end effector 1052along the X_(t) axis thereof (e.g. longitudinally), forces on thecentral portion 4002 in the Y direction correspond to displacement ofthe end effector 1052 along the Y_(t) axis thereof (e.g. laterally), andforces on the central portion 4002 in the Z direction correspond todisplacement of the end effector 1052 along the Z_(t) axis (e.g.vertically/up and down). Additionally, forces on the central portion4002 about the X axis (the moment forces R) result in rotation of theend effector 1052 about the X_(t) axis (e.g. a rolling motion about alongitudinal axis in the direction R_(t)), forces on the central portion4002 about the Y axis (the moments forces P) result in articulation ofthe end effector 1052 about the Y_(t) axis (e.g. a pitching motion inthe direction Pt), and forces on the central portion 4002 about the Zaxis (the moment forces T) result in articulation of the end effector1052 about the Z_(t) axis of the end effector (e.g. a yawing or twistingmotion in the direction T_(t)). In such instances, the input controldevice 4000 includes a six-degree of freedom joystick, for example,which is configured to receive and detect six degree-of-freedom-forcesalong the X, Y, and Z axes and moments about the X, Y, and Z axes. Theforces can correspond to translational input and the moments cancorrespond to rotational inputs for the end effector 1052 of theassociated surgical tool 1050. Six degree-of-freedom input devices arefurther described herein.

Referring again to the input control device 4000 in FIGS. 44-49 , aforearm support 4008 is movably coupled to the base 4004. For example, amechanical joint 4042 incorporated into the central portion 4002 canhold or support the forearm support 4008 such that the forearm support4008 is movable at the mechanical joint 4042 relative to the base 4004.Referring primarily now to FIG. 47 , the forearm support 4008 is shownin a first configuration (solid lines) and in a second configuration(dashed lines). The base 4004 of the input control device 4000 remainsstationary as an upper portion (e.g. a collective unit 4011 describedherein) of the input control device 4000 is displaced along alongitudinal shaft axis S, which extends parallel to the longitudinal Xaxis, between the first configuration and the second configuration. Incertain instances, the mechanical joint 4042 can permit movement of theforearm support 4008 relative to the base 4004 in multiple directions.For example, the forearm support 4008 can be moveable relative to thebase 4004 along one, two or three different axes.

The forearm support 4008 can be movable within a range of motion definedby a travel zone 4050 (FIG. 47 ) surrounding a forearm home position.For example, the travel zone 4050 can define a one-dimensional path fromthe forearm home position, wherein the one-dimensional path extendsalong a longitudinal axis between 2.0 cm and 6.0 cm from the forearmhome position. Referring again to FIG. 47 , in the first configuration(indicated as input control device 4000 in solid lines), the inputcontrol device 4000 has been moved proximally along the longitudinalshaft axis S to the proximal end or limit of the travel zone 4050 and,in the second configuration (indicated as input control device 4000′ indashed lines), the input control device 4000 has been moved distallyalong the longitudinal shaft axis S to the distal end or limit of thetravel zone 4050. In various instances, the travel zone 4050 can definea two-dimensional space extending between 2.0 cm and 6.0 cm in twodimensions from the forearm home position. In still other instances, thetravel zone 4050 can define a three-dimensional space extending between2.0 cm and 6.0 cm in three dimensions from the forearm home position.The type and/or arrangements of joints at the mechanical joint 4042 candetermine the degrees of freedom of the forearm support 4008 relative tothe base 4004. The mechanical joint 4042, which is supported and/orbuilt on the central portion 4002 of the space joint 4006 can includeelastically-coupled components, sliders, journaled shafts, hinges,and/or rotary bearings, for example.

The degrees of freedom and the dimensions of the travel zone 4050 can beselected to provide the surgeon with first-person perspective control ofthe end effector (i.e. from the surgeon's perspective, being“positioned” at the jaws of the remotely-positioned end effector at thesurgical site). In various instances, motion of a handpiece 4020 on theinput control device 4000 can correspond to one-to-one correspondingmotion of the surgical end effector. For example, moving the handpiece4020 distally along the shaft axis S a distance of 1.0 cm can correspondto a distal displacement of the end effector a distance of 1.0 cm alongthe longitudinal shaft axis S of the surgical tool. Similarly, rotatingthe handpiece 4020 at a wrist or joint 4010 counterclockwise fivedegrees can correspond to a rotational displacement of the end effectorby five degrees in the counterclockwise direction. In various instances,the input control motions to the control input device 4000 can bescaled, as further described herein and in various co-owned applicationsthat have been incorporated by reference herein.

The input control device 4000 also includes a shaft 4012 extendingdistally from the forearm support 4008 and the handpiece 4020 extendingdistally from the shaft 4012. The forearm support 4008, the shaft 4012,and the handpiece 4020 form a collective unit 4011, which is movabletogether as the forearm support 4008 is moved relative to the base 4004within the travel zone 4050 defined by the mechanical joint 4042. Adisplacement sensor is configured to detect movement of the collectiveunit 4011. The handpiece 4020 defines an end effector actuator having atleast one jaw, as further described herein. The shaft 4012 includes alinear portion extending along the shaft axis S that is parallel to theaxis X in the configuration shown in FIG. 6 . The shaft 4012 alsoincludes a contoured “gooseneck” portion 4018 that curves away from theshaft axis S to position the handpiece 4020 in a comfortable positionand orientation for the surgeon relative to the forearm support 4008.For example, the contoured portion 4018 defines a curvature of about 90degrees. In other instances, the curvature can be less than 90 degreesor more than 90 degrees and can be selected based on the surgeon'spreference(s) and/or anthropometrics, for example.

The shaft 4012 supports the wrist 4010 intermediate the linear portionand the contoured portion 4018. For example, the wrist 4010 can bepositioned at the distal end of the linear portion, such that thecontoured portion 4018 is configured to rotate relative to the linearportion upon application of manual control motions thereto. The wrist4010 is longitudinally offset from the space joint 4006. The wrist 4010defines a mechanical joint to facilitate rotary motion. The wrist 4010can include elastically-coupled components, sliders, journaled shafts,hinges, and/or rotary bearings, for example. The wrist 4010 can alsoinclude a rotary sensor (e.g. the sensor 1049 in FIG. 25 ), which can bea rotary force/torque sensor and/or transducer, rotary strain gauge,strain gauge on a spring, rotary encoder, and/or an optical sensor todetect rotary displacement at the joint, for example.

The wrist 4010 can define input control motions for at least one degreeof freedom. For example, the wrist 4010 can define the input controlmotions for the rolling motion of a robotic end effector controlled bythe input control device 4000. Rotation of the wrist 4010 by the surgeonto roll an end effector provides control of the rolling motion at thesurgeon's fingertips and corresponds to a first-person perspectivecontrol of the end effector (i.e. from the surgeon's perspective, being“positioned” at the jaws of the remotely-positioned end effector at thesurgical site). As further described herein, such placement andperspective can be utilized to supply precision control motions to theinput control device 4000 during portions of a surgical procedure (e.g.a precision motion mode).

In certain instances, the input control device 4000 can includeadditional wristed joints. For example, the shaft 4012 can include oneor more additional rotary joints along the length thereof, such as at ajuncture or junction 4014 (FIG. 44 ) along a linear portion of the shaft4012 and/or at a juncture or junction 4016 at the distal end of thecontoured portion 4018 of the shaft 4012. For example, a mechanicaljoint at the junction 4016 can permit articulation of the handpiece 4020relative to the shaft 4012 about at least one axis. In variousinstances, the handpiece 4020 can be articulated about at least two axes(e.g. the axis Z₁ that is parallel to the axis Z in FIG. 45 and the axisY₁ that is parallel to the axis Y in FIG. 45 ). The additional jointscan provide additional degrees of freedom for the input control device4000, which can detected by a sensor arrangement and converted to rotaryinput control motions for the end effector, such as a yawing or pitchingarticulation of the end effector. Such an arrangement requires one ormore additional sensor arrangements to detect the rotary input at thejunction 4016, for example.

As further described herein, the space joint 4006 can define the inputcontrol motions for multiple degrees of freedom. For example, the spacejoint 4006 can define the input control motions for translation of thesurgical tool in three-dimensional space and rotation of the surgicaltool about at least one axis. Rolling motions can be controlled byinputs to the space joint 4006 and/or the wrist 4010. Whether a rollingcontrol motion is provided by the wrist 4010 or the space joint 4006 ofthe input control device 4000 can depend on the actions of the surgeonand/or the operational mode of the input control device 4000, as furtherdescribed herein. Articulation motions can be controlled by inputs tothe space joint 4006 and/or the junction 4016. Whether an articulationcontrol motion is provided by the junction 4016 or the space joint 4006of the input control device 4000 can depend on the actions of thesurgeon and/or the operational mode of the input control device 4000, asfurther described herein.

The handpiece 4020 includes an end effector actuator having opposingfingers 4022 extending distally from the shaft 4012. The opposingfingers 4022 can be similar to the fingers 1022 (FIGS. 6-11 ) in manyrespects. Applying an actuation force to the opposing fingers 4022comprises an input control motion for a surgical tool. For example,referring again to FIG. 12 , applying a pinching force to the opposingfingers 4022 can close and/or clamp the jaws 1054 of the end effector1052 (see arrows C in FIG. 12 ). In various instances, applying aspreading force can open and/or release the jaws 1054 of the endeffector 1052, such as for a spread dissection task, for example. Thefingers 4022 also includes loops 4030, which are similar to the loops1030 (FIGS. 6-11 ) in many respects. The opposing fingers 4022 can bedisplaced symmetrically or asymmetrically relative to the longitudinalshaft axis S during an actuation. The displacement of the opposingfingers 4022 can depend on the force applied by the surgeon, forexample, and a desired surgical function. The input control device 4000includes at least one additional actuator, such as the actuation buttons4026, 4028, for example, which can provide additional controls at thesurgeon's fingertips, e.g. the surgeon's index finger I, similar to theactuation buttons 1026, 1028 (FIGS. 6-11 ) in many respects. The readerwill appreciate that the actuation buttons 4026, 4028 can have differentgeometries and/or structures, and can include a trigger, a button, aswitch, a lever, a toggle, and combinations thereof.

Referring primarily to FIGS. 48 and 49 , during use, a surgeon canposition a portion of his or her arm on the forearm support 4008 and canprovide forces to the space joint 4006 via inputs at the forearm support4008. The surgeon's forearm can be positioned on the lower portion ofthe forearm support 4008 and a cuff or sleeve of the forearm support4008 can at least partially surround the surgeon's arm in certaininstances. For example, the forearm support 4008 forms a partial loophaving a curvature of more than 180 degrees. In certain instances, thecurvature can define an arc of approximately 270 degrees, for example.In other instances, the cuff or sleeve can form an enclosed loop throughwhich the surgeon can position his or her arm. Alternative geometriesfor the forearm support are envisioned. The surgeon's thumb T ispositioned through one of the loops 4030 and the surgeon's middle fingerM is positioned through the other loop 4030. In such instances, thesurgeon can pinch and/or spread his thumb T and middle finger M toactuate the opposing fingers 4022. The distally-extending fingers 4022(for actuation of the jaws) and the actuation buttons 4026, 4028 (foractuation of a surgical function at the jaws) are distal to the spacejoint 4006 and wrist 4010. Such a configuration mirrors theconfiguration of a surgical tool in which the end effector is distal tothe more-proximal articulation joint(s) and/or rotatable shaft and,thus, provides an intuitive arrangement that facilitates a surgeon'straining and adoption of the input control device 4000.

In various instances, the input controls for the input control device4000 are segmented between first control motions and second controlmotions, similar in many aspects to the operational modes described withrespect to the input control device 1000 (FIGS. 6-11 ). Control logicfor the input control device 4000 can be utilized in the control circuit832 (FIG. 25 ), the control circuit 1400 (FIG. 11C), the combinationallogical circuit 1410 (FIG. 11D), and/or the sequential logic circuit1420 (FIG. 11E), for example, where an input is provided from inputs tothe input control device 4000 and/or a surgical visualization system ordistance determining subsystem thereof, as further described herein.Inputs from the input control device 4000 include feedback from thevarious sensors thereof and related to control inputs at the space joint4006, the wrist 4010, and/or the handpiece 4020, for example.

Referring now to FIG. 50 , control logic 4068 for the input controldevice 4000 can activate or maintain a gross motion mode at a block 4082if the distance (d_(t)) determined by a distance determining subsystemis greater than or equal to a threshold distance (D_(critical)) and candeactivate the gross motion mode at a block 4076 if the distance (d_(t))is less than the threshold distance (D_(critical)). More specifically,when a force is initially applied to the forearm support 4008 to movethe forearm support 4008 to the end of its constrained travel zone (e.g.a boundary of the travel zone 4050 in FIG. 47 ) at a block 4070, therobotic surgical tool is controlled to move at a surgical site relativeto relevant tissue at a block 4072. In various instances, the forcerequired to input control motions via the sensor arrangement 4048 (FIG.46 ) can be greater than the force required to move the forearm support4008 to the end of its travel zone. In other words, the surgeon can movethe forearm support 4008 to the ends of its travel zone before effectingcontrol motions with the sensor arrangement 4048.

As the robotic surgical tool is moved relative to tissue, the controllogic checks proximity data provided by a tissue proximity detectionsystem to determine if the distance (d_(t)) is greater than or equal toa threshold distance (D_(critical)) at a block 4074. The control logic4068 can periodically and/or continuously compare the distance (d_(t))to the threshold distance (D_(critical)) during the surgical procedure(e.g. intraoperatively and/or in real-time). The threshold distance(D_(critical)) can be set by the surgeon in certain instances. Moreover,the surgeon may selectively override the default rules and conditions ofthe control logic 4068, such as the rules related to the comparison at ablock 4074 and/or adjustments to the threshold distance (D_(critical)),for example.

If the distance (d_(t)) is greater than or equal to the thresholddistance (D_(critical)), the gross motion mode can be activated at ablock 4082. As a force continues to be applied to the forearm support4008 to move the forearm support 4008 to the end of its constrainedtravel zone (the block 4070) and moves the tool relative to tissue (theblock 4072), the control circuit can continue to monitor the distance(d_(t)) (the block 4074) and maintain the gross motion mode (block 4082)while the distance (d_(t)) is greater than or equal to the thresholddistance (D_(critical)).

If the distance (d_(t)) becomes less than the threshold distance(D_(critical)), the gross motion mode can be deactivated at a block4076. With the gross motion mode deactivated, control motions for therobotic tool can be controlled with limited translation of the forearmsupport 4008 within the travel zone at a block 4078 (e.g. the travelzone 4050 in FIG. 47 ) and/or with the actuations to the wrist(s) (e.g.the wrist 4010 and/or the junction 4016) and/or to the handpiece 4020 ata block 4080. The control circuit can continue to monitor the distance(d_(t)) (the block 4074) and deactivate the gross motion mode (the block4076) as long as the distance (d_(t)) is less than the thresholddistance (D_(critical)).

During the gross motion mode, the surgical tool and end effector thereofcan be driven in the directions detected by the forces at the spacejoint 4006 and applied by the forearm support 4008 until the forces areremoved and the central portion 4002 is biased back to the homeposition. Upon removal of the forces to the space joint 4006 during thegross motion mode, the driving forces supplied to the end effector canterminate as well.

Referring again to FIGS. 44-49 , the input control device 4000 has beendescribed as having a mechanical joint 4042 intermediate the space joint4006 and the forearm support 4008, which permits movement of the forearmsupport 4008 (and the entire collective unit 4011) relative to the base4004 within the travel zone 4050. The travel zone 4050 can provide aprecision control zone for the surgeon to move the handpiece 4020 tosupply precision control motions to an end effector. In other instances,similar to the input control device 1000, for example, the input controldevice 4000 may not include the additional mechanical joint 4042intermediate the space joint 4006 and the forearm support 4008. In suchinstances, precision control motions can be applied to the space joint4006; however, such control motions can be scaled according to data froma tissue proximity detection system as further described herein. Scalingalgorithms can also be applied to the input control device 4000, forexample.

Referring now to FIGS. 51 and 52 , an input control device 4100 isshown. The input control device 4100 is similar to the input controldevice 4000 (FIGS. 44-49 ) in many respects. For example, the inputcontrol device 4100 includes a base 4104, a central portion 4102supported relative to the base 4104, and a space joint 4106therebetween. A power cord 4132 extends from the base 4104. Moreover, acollective unit 4111 is supported by the central portion 4102 andincludes a forearm support 4108, a distally-extending shaft 4112, and adistally-ending handpiece 4120 includes a pair of opposing jaws 4122 andactuation buttons 4126, 4128. The collective unit 4111 can furtherinclude at least one wristed joint along the shaft 4112 as describedherein with respect to the input control device 4000. However, the inputcontrol device 4100 does not include a mechanical joint that allows thecollective unit 4111 to move within a travel zone relative to the base4104. Moreover, unlike the forearm support 4008, the forearm support4108 forms a partial loop having a curvature of less than 180 degrees.The reader will readily appreciate that a wide range of input controldevices incorporating various features of the input control devices 4000and 4100 may be designed based on formative testing and userpreferences. A robotic system can allow for users to choose from avariety of different forms to select the style that best suits his/herneeds.

Referring now to FIGS. 53-56 , an input control device 4200 is shown.The input control device 4200 is a clutchless input control device, asfurther described herein. The input control device 4200 can be utilizedat a surgeon's console or workspace for a robotic surgical system. Forexample, the input control device 4200 can be incorporated into asurgical system, such as the surgical system 110 (FIG. 1 ) or thesurgical system 150 (FIG. 3 ), for example, to provide control signalsto a surgical robot and/or surgical tool coupled thereto. The inputcontrol device 4200 includes manual input controls for moving therobotic arm and/or the surgical tool in three-dimensional space. Forexample, the surgical tool controlled by the input control device 4200can be configured to move in three-dimensional space and rotate orarticulate about multiple axes (e.g. roll about a longitudinal tool axisand articulate about one or more articulation axes).

The input control device 4200 includes a multi-dimensional space joint4206 having a central portion 4202 supported on a base 4204, similar tothe multi-dimensional space joint 1006, the central portion 1002, andthe base 1004 of the input control device 1000 (FIGS. 6-11 ) in manyrespects. The base 4204 is structured to rest on a surface, such as adesk or work surface at a surgeon's console or workspace and can remainin a fixed, stationary position relative to an underlying surface uponapplication of the input control motions to the input control device4200. The base 4204 includes a wide curved foot portion 4203, which canprovide stability to the balanced and gravity compensated geometry ofthe input control device. The base 4204 also includes an upright portion4205 for suspending or hanging the central portion 4202 above the footportion 4203. The space joint 4206 is configured to receivemulti-dimensional inputs corresponding to control motions for thesurgical tool in multi-dimensional space. The input control device 4200also include a multi-axis force and/or torque sensor arrangement 4248(FIG. 54 ), similar to the sensor arrangement 1048 (FIGS. 8 and 9 ) inmany respects. For example, the sensor arrangement 4248 is configured todetect forces and moments at the space joint 4206, such as forcesapplied to the central portion 4202. Multi-dimensional space joints andsensor arrangements therefor are further described herein.

The central portion 4202 can be flexibly supported relative to the base4204. In such instances, the central portion 4202 can be configured tomove or float within a small predefined zone upon receipt of forcecontrol inputs thereto. For example, the central portion 4202 can be afloating shaft that is supported on the base 4204 by one or moreelastomeric members such as springs, for example. The central portion4202 can be configured to move or float within a predefinedthree-dimensional volume. For example, elastomeric couplings can permitmovement of the central portion 4202 relative to the base 4204; however,restraining plates, pins, and/or other structures can be configured tolimit the range of motion of the central portion 4202 relative to thebase 4204. In one aspect, movement of the central portion 4202 from acentral or “home” position relative to the base 4204 can be permittedwithin a range of about 1.0 mm to about 5.0 mm in any direction (up,down, left, right, backwards, and forwards). In other instances,movement of the central portion 4202 relative to the base 4204 can berestrained to less than 1.0 mm or more than 5.0 mm. In certaininstances, the central portion 4202 can move about 2.0 mm in alldirections relative to the base 4204 and, in still other instances, thecentral portion 4202 can remain stationary or fixed relative to the base4204.

In various instances, the central portion 4202 of the space joint 4206can be spring-biased toward the central or home position, in which thecentral portion 4202 is aligned with the X axis, a horizontal axisthrough the central portion 4202 and the space joint 4206. Driving (e.g.pushing and/or pulling) the central portion 4202 away from the X axis inany direction can be configured to “drive” an end effector of anassociated surgical tool in the corresponding direction. When theexternal driving force is removed, the central portion 4202 can beconfigured to return to the central or home position and motion of theend effector can be halted.

In various instances, the space joint 4206 and the central portion 4202coupled thereto define a six degree-of-freedom input control. Referringagain now to the end effector 1052 of the surgical tool 1050 in FIG. 12, the forces on the central portion 4202 of the input control device4200 in the X direction correspond to displacement of the end effector1052 along the X_(t) axis thereof (e.g. longitudinally), forces on thecentral portion 4202 in the Y direction correspond to displacement ofthe end effector 1052 along the Y_(t) axis thereof (e.g. laterally), andforces on the central portion 4202 in the Z direction correspond todisplacement of the end effector 1052 along the Z_(t) axis (e.g.vertically/up and down). Additionally, forces on the central portion4202 about the X axis (the moment forces R) result in rotation of theend effector 1052 about the X_(t) axis (e.g. a rolling motion about alongitudinal axis in the direction R_(t)), forces on the central portion4202 about the Y axis (the moments forces P) result in articulation ofthe end effector 1052 about the Y_(t) axis (e.g. a pitching motion inthe direction Pt), and forces on the central portion 4202 about the Zaxis (the moment forces T) result in articulation of the end effector1052 about the Z_(t) axis of the end effector (e.g. a yawing or twistingmotion in the direction T_(t)). In such instances, the input controldevice 4200 includes a six-degree of freedom joystick, for example,which is configured to receive and detect six degree-of-freedom-forcesalong the X, Y, and Z axes and moments about the X, Y, and Z axes. Theforces can correspond to translational input and the moments cancorrespond to rotational inputs for the end effector 1052 of theassociated surgical tool 1050. Six degree-of-freedom input devices arefurther described herein.

Referring again to the input control device 4200 in FIGS. 53-56 , ahandpiece 4220 including a shaft 4212 is movably coupled to the base4204 by a mechanical linkage assembly 4208. The mechanical linkageassembly 4208 includes three arms 4208 a, 4208 b, 4208 c and each arm4208 a, 4208 b, 4208 c includes a series of linkages and jointstherebetween. The arms 4208 a, 4208 b, 4208 c are rotationally orradially symmetric about the X axis. Each arm 4208 a, 4208 b, and 4208 cincludes two linkages and three joints. The reader will appreciate thatalternative configurations and geometries for the mechanical linkageassembly 4208 are envisioned. For example, the mechanical linkageassembly 4208 can include less than three or more than three arms andeach arm can includes a different number of linkages and joints.Moreover, the types of joints can be selected to further constrainand/or permit types and/or degrees of rotational movement.

Referring primarily now to FIG. 54 , the mechanical linkage assembly4208 is shown in a first configuration (solid lines) and in a secondconfiguration (dashed lines). The base 4204 of the input control device4200 remains stationary as an upper portion (a collective unit 4211) ofthe input control device 4200 is displaced along a longitudinal shaftaxis S, which extends parallel to the longitudinal X axis in FIG. 54 ,between the first configuration and the second configuration. In certaininstances, the mechanical linkage assembly 4208 can permit movement ofthe shaft 4212 and the handpiece 4220 relative to the base 4204 inmultiple directions. For example, the mechanical linkage assembly 4208can be moveable relative to the base 4204 along one, two or threedifferent axes.

The mechanical linkage assembly 4208 can be movable within a range ofmotion defined by a travel zone surrounding a linkage home positionshown in FIG. 53 , for example. In certain instances, the travel zonecan define a one-dimensional path from the linkage home position,wherein the one-dimensional path extends along the longitudinal shaftaxis X between 2.0 cm and 6.0 cm from the linkage home position.Referring again to FIG. 54 , in the first configuration (solid lines),the input control device 4200 has been moved proximally along thelongitudinal axis to the proximal end or limit of the travel zone and,in the second configuration (dashed lines), the input control device4200 has been moved distally along the longitudinal axis to the distalend or limit of the travel zone. In other instances, the travel zone candefine a two-dimensional space extending between 2.0 cm and 6.0 cm intwo dimensions from the linkage home position. In still other instances,the travel zone can define a three-dimensional space extending between2.0 cm and 6.0 cm in three dimensions from the linkage home position.The type and/or arrangements of joints and linkages in the mechanicallinkage assembly 4208 can determine the degrees of freedom of thehandpiece 4220 and shaft 4212 relative to the base 4204. The mechanicallinkage assembly 4208, which is supported and/or built on the centralportion 4202 of the space joint 4206, can include elastically-coupledcomponents, sliders, journaled shafts, hinges, and/or rotary bearings,for example.

The degrees of freedom and the dimensions of the travel zone can beselected to provide the surgeon with first-person perspective control ofthe end effector (i.e. from the surgeon's perspective, being“positioned” at the jaws of the remotely-positioned end effector at thesurgical site). In various instances, motion of the shaft 4212 cancorrespond to one-to-one corresponding motion of the surgical endeffector. For example, moving the shaft 4212 distally along the shaftaxis S a distance of 1.0 cm can correspond to a distal displacement ofthe end effector a distance of 1.0 cm along the longitudinal shaft axisof the surgical tool. Similarly, rotating the handpiece 4220 at a wristor joint 4210 in the shaft 4212 counterclockwise five degrees cancorrespond to a rotational displacement of the end effector by fivedegrees in the counterclockwise direction. In various instances, theinput control motions to the input control device 4200 can be scaled, asfurther described herein and in various co-owned applications that havebeen incorporated by reference herein.

The shaft 4212 extends proximally from the mechanical linkage assembly4208 and the handpiece 4220 extends proximally from the shaft 4212. Themechanical linkage assembly 4208, the shaft 4212, and the handpiece 4220form the collective unit 4211, which is movable together as themechanical linkage assembly 4208 is moved relative to the base 4204within the travel zone. A displacement sensor is configured to detectmovement of the collective unit 4211. The handpiece 4220 defines an endeffector actuator having at least one jaw, as further described herein.

The shaft 4212 supports the wrist 4210 along the length thereof. Thewrist 4210 is longitudinally offset from the space joint 4206 anddefines a mechanical joint to facilitate rotary motion. The wrist 4210can include elastically-coupled components, sliders, journaled shafts,hinges, and/or rotary bearings, for example. The wrist 4210 can alsoinclude a rotary sensor (e.g. the sensor 1049 in FIG. 25 ), which can bea rotary force/torque sensor and/or transducer, rotary strain gaugeand/or strain gauge on a spring, and/or an optical sensor to detectrotary displacement at the joint, for example.

The wrist 4210 can define input control motions for at least one degreeof freedom. For example, the wrist 4210 can define the input controlmotions for the rolling motion of a robotic end effector controlled bythe input control device 4200. Rotation of the wrist 4210 by the surgeonto roll an end effector provides control of the rolling motion at thesurgeon's fingertips and corresponds to a first-person perspectivecontrol of the end effector (i.e. from the surgeon's perspective, being“positioned” at the jaws of the remotely-positioned end effector at thesurgical site). As further described herein, such placement andperspective can be utilized to supply precision control motions to theinput control device 4200 during portions of a surgical procedure (e.g.a precision motion mode).

In certain instances, the input control device 4200 can includeadditional wristed joints, as described with respect to the inputcontrol device 4000 (FIGS. 44-49 ), for example, and sensor arrangementsto detect the rotary input motions thereto. In other instances, themechanical linkage assembly 4208 can provide sufficient degrees offreedom to precisely control a robotic surgical tool at a surgical site.Sensor arrangements on the mechanical linkage assembly 4208 can beemployed to detect rotary user input motions thereto.

As further described herein, the space joint 4206 can define the inputcontrol motions for multiple degrees of freedom. For example, the spacejoint 4206 can define the input control motions for translation of thesurgical tool in three-dimensional space and rotation of the surgicaltool about at least one axis. Rolling motions can be controlled byinputs to the space joint 4206 and/or the wrist 4210. Whether a rollingcontrol motion is provided by the wrist 4210 or the space joint 4206 ofthe input control device 4200 can depend on the actions of the surgeonand/or the operational mode of the input control device 4200, as furtherdescribed herein. Articulation motions can be controlled by inputs tothe space joint 4206 and/or the mechanical linkage assembly 4208.Whether an articulation control motion is provided by the mechanicallinkage assembly 4208 or the space joint 4206 of the input controldevice 4200 can depend on the actions of the surgeon and/or theoperational mode of the input control device 4200, as further describedherein.

The handpiece 4220 includes an end effector actuator having opposingfingers 4222 extending distally from the shaft 4212. The opposingfingers 4222 can be similar to the fingers 1022 (FIGS. 6-11 ) in manyrespects. Applying an actuation force to the opposing fingers 4222comprises an input control motion for a surgical tool. For example,referring again to FIG. 12 , applying a pinching force to the opposingfingers 4222 can close and/or clamp the jaws 1054 of the end effector1052 (see arrows C in FIG. 12 ). In various instances, applying aspreading force can open and/or release the jaws 1054 of the endeffector 1052, such as for a spread dissection task, for example. Thefingers 4222 also includes loops 4230, which are similar to the loops1030 (FIGS. 6-11 ) in many respects. The opposing fingers 4222 can bedisplaced symmetrically or asymmetrically relative to the longitudinalshaft axis S during an actuation. The displacement of the opposingfingers 4222 can depend on the force applied by the surgeon, forexample, and a desired surgical function. The input control device 4200includes at least one additional actuator, such as the actuation buttons4226, 4228, for example, which can provide additional controls at thesurgeon's fingertips, similar to the actuation buttons 1026, 1028 (FIGS.6-11 ) in many respects.

Referring primarily to FIGS. 55 and 56 , during use, a surgeon canposition his or her hand relative to the handpiece 4220 to reach thefingers 4222 and the actuation buttons 4226, 4228. The surgeon's thumb Tis positioned through one of the loops 4230 and the surgeon's middlefinger M is positioned through the other loop 4230. In such instances,the surgeon can pinch and/or spread his thumb T and middle finger M toactuate the fingers 4222.

In various instances, the input controls for the input control device4200 are segmented between first control motions and second controlmotions, similar in many aspects to the operational modes described withrespect to the input control device 1000 (FIGS. 6-11 ). Control logicfor the input control device 4200 can be utilized in the control circuit832 (FIG. 25 ), the control circuit 1400 (FIG. 11C), the combinationallogical circuit 1410 (FIG. 11D), and/or the sequential logic circuit1420 (FIG. 11E), for example, where an input is provided from inputs tothe input control device 4200 and/or a surgical visualization system ordistance determining subsystem thereof, as further described herein.Inputs from the input control device 4200 include feedback from thevarious sensors thereof and related to control inputs at the space joint4206, the mechanical linkage assembly 4208, the wrist 4210, and/or thehandpiece 4220, for example.

In certain instances, the input control device 4200 can operate thecontrol logic 4068 of FIG. 50 . In such instances, input control motionsin the gross motion mode (activated at block 4082) can be applied whenthe mechanical linkage assembly 4208 is positioned in the Mode B zoneshown in FIG. 54 . In such a position, the user input forces can besupplied to the space joint 4206 and detected by the multi-axis forceand torque sensor arrangement 4248 (FIG. 54 ). Upon deactivation of thegross motion mode, precision control input motions can be applied viainputs to the handpiece 4220 when the mechanical linkage assembly 4208is in the Mode A zone shown in FIG. 54 . For example, a surgeon canutilized one-to-one movements of the handpiece 4220 to control operationof the surgical end effector position in close proximity to tissue.

With certain robotic surgical systems and/or input control devicestherefor, a surgeon may need to remain at the surgeon's console orworkspace as long as he or she remains involved in the surgicalprocedure and/or actively controlling a robotic surgical tool. Becausethe surgeon's console can be fixed at a particular location (e.g. withinthe operating room but outside of the sterile field), the surgeon may beunable to move around the surgical theater and/or move in and out of thesterile field. When the mobility of the surgeon is restricted, thesurgeon may be unable to obtain first-hand information regarding thepatient and/or status of the patient and/or other conditions within theoperating room (e.g. the status of supplies, condition of theassistants, etc.).

To increase the mobility of the surgeon, an input control device can beungrounded or untethered from a surgeon's console. Such an input controldevice can be wireless handpiece that is movable in three-dimensionalspace. In such instances, the input control device may not utilize abase or docking station to detect and/or deliver input control motionssupplied to the handpiece. A motion capture system can detect movementof the handpiece with respect to multiple degrees of freedom. Forexample, the motion capture system can detect input control motions bythe user to the handpiece in three-dimensional space includingrotational displacements of the handpiece. In such instances, the inputcontrol device can be a clutchless input control device in that thehandpiece does not require use of a clutch mechanism to electronicallydisengage from control of the robotic surgical tool in order to maintainthe handpiece within a work envelope that is defined by the position andstructure of the input control device and the surgeon at a surgeon'sconsole therefor.

The wireless handpiece for the input control device can also include arolling input component (e.g. a rotary shaft and rotary sensor) and oneor more actuation buttons or inputs for receiving control inputs fromthe surgeon. The rolling input component can supply rolling controlinput motions, which correspond to rolling motions for an end effectorof the robotic surgical tool controlled by the input control device.Additional actuation buttons can actuate a surgical function of the endeffector, such as a firing motion, energizing function, coolingfunction, irrigation function, and/or adjustment to a clamping pressureand/or tissue gap, for example. Additional surgical functions for arobotic surgical tool are further described herein. In certaininstances, the handpiece can also include an additional input controlactuator on the handpiece, such as a pivotable arm or lever, to which asurgeon can supply control motions for moving the surgical tool inthree-dimensional space. For example, the pivotable arm can define ajoystick operably coupled to a multi-axis force sensor, as furtherdescribed herein.

The controls for such an input control device can be segmented indifferent operational modes. For example, first input control motionscan be utilized in a first mode, e.g. a gross motion mode, and secondinput control motions can be utilized in a second mode, e.g. a precisionmotion mode. The non-utilized input control motions can be selectivelylocked out or ignored by a control circuit when they are not beingutilized to control the robotic surgical tool.

In one aspect, a control unit can toggle the input control devicebetween the gross motion mode and the precision motion mode based onintraoperative tissue proximity data from a proximity detection system,as further described herein. In the first mode, control input motionscan be provided by the joystick and multi-axis force sensor coupledthereto, for example. Movement of the joystick can provide gross motioncontrol inputs to the robotic surgical tool in the gross motion mode.For example, the joystick can be moved relative to X, Y, and/or Z axes,which corresponds to control motions for moving the robotic surgicaltool in the X, Y, and/or Z axes thereof. Forces supplied by the joystickcan correspond to displacements of the robotic surgical tool enablingthe clutchless functionality of the input control device.

In certain instances, the sensitivity of inputs to the joystick candecrease as the surgical tool approaches tissue and, in certaininstances, can be deactivated or locked out upon detecting a tissueproximity of less than or equal to a threshold distance. For example,the handpiece can include a mechanical and/or electronic lock for thejoystick. The lock can be movable from an unlocked position to a lockedposition in response to switching from the gross motion mode to theprecision motion mode.

In the precision motion mode, the motion capture system can detectmotion of the handpiece and provide precision motion control inputs tothe robotic surgical tool based on the detected motion. For example, thehandpiece can be moved relative to the X, Y, and/or Z axes and/orarticulated with respect to one or more different articulation axes,which corresponds to control motions for moving and/or articulating therobotic surgical tool accordingly. Additional features and variations tountethered, ungrounded input control devices are further describedherein.

When the surgeon involved in the surgical procedure is not required toremain at a surgeon's console or predetermined location, as provided bythe untethered, ungrounded input control device further describedherein, the surgeon can move around the surgical theater and/or move inand out of the sterile field, for example. The increased mobilityallowance for the surgeon can allow the surgeon to relocate in order toobtain first-hand information regarding the patient and/or a statuswithin the operating room, rather than relying on information providedat the surgeon's console (e.g. obtained by cameras and relayed to animaging system) and/or second-hand information provided by assistantsand/or others within the operating room. Additionally, the untethered orungrounded input control device allows the surgeon to select acomfortable ergonomic position from a wide range of postures, includingsitting, kneeling, and standing postures without consideration for asupport surface for the input control device. Because the surgeon canselect a comfortable posture for him/herself and adjust his/her posturethroughout the surgical procedure, the ergonomic effects on the surgeonare improved. Additionally, a clutching mechanism is not required toutilize such an input control device.

Referring now to FIGS. 57-61 , an input control device 5000 is shown.The input control device 5000 can be incorporated into a surgicalsystem, such as the surgical system 110 (FIG. 1 ) or the surgical system150 (FIG. 3 ), for example, to provide control signals to a surgicalrobot and/or surgical tool coupled thereto. The input control device5000 includes manual input controls for moving the robotic arm and/orthe surgical tool in three-dimensional space. The input control device5000 includes sufficient degrees of freedom to control the roboticsurgical tool 1050 shown in FIG. 12 , for example. The input controldevice 5000 includes a handpiece 5002 that is configured to be held bythe surgeon. For example, a surgeon can hold the handpiece 5002 as shownin FIGS. 60 and 61 . The handpiece 5002 is untethered or ungrounded.Moreover, the handpiece 5002 is a wireless handpiece 5002. Referringprimarily to FIG. 59A, the handpiece 5002 can includes a power source5054 and a control circuit 5048 having wireless communicationcapabilities with external components. For example, the handpiece 5002can include one or more communication modules. Because the communicationdoes not require high powered signals, near-field communicationprotocols can be utilized in various instances.

The handpiece 5002 includes an elongate body 5004. The surgeon can graspthe elongate body 5004 between his or her palm and fingers to hold thehandpiece 5002. The elongate body 5004 can be dimensioned and structuredfor comfortable grasping by the surgeon and can include contoured edgesand a generally cylindrical shape, for example.

The handpiece 5002 also includes a joystick 5006, which extendsproximally from the elongate body 5004. The joystick 5006 can define acircular ring and/or a looped structure 5008, which can permitengagement with a surgeon's digits, such as the surgeon's thumb. Asurgeon's thumb (T) engaged with the ring 5008 is shown in FIGS. 60 and61 . The joystick 5006 is operably coupled to a multi-axis force sensor5010 (FIG. 59A), which can be similar to the multi-axis force and torquesensor 1048 (FIGS. 8 and 9 ) in many respects. The joystick 5006 can beflexibly supported at a space joint 5012, which can be similar to thespace joint 1006 (FIGS. 6-11 ) in many respects. In various instances,the joystick 5006 can be spring-biased toward a home position. In otherinstances, the joystick 5006 may be essentially fixed relative to thehandpiece 5002.

The surgeon can be configured to supply input control forces to thejoystick 5006, which are detected by the multi-axis force sensor 5010.For example, the multi-axis force sensor 5010 can be configured todetect input forces in multiple dimensions, such as forces along the X,Y, and Z axes shown in FIG. 57 . In certain instances, the multi-axisforce sensor 5010 can also be configured to detect input moments inmultiple dimensions, such as the moments R, P and T about the axes X, Y,and Z, respectively, in FIG. 57 . However, as further described herein,in at least one aspect of the present disclosure, the rotation orarticulation of the robotic surgical tool can be controlled by differentinputs and, in such instances, the multi-axis force sensor 5010 may notdetect and/or utilize moments applied to the joystick 5006. Moreover, incertain instances, a sensor for the joystick 5006 can be configured todetect displacement of the joystick 5006 instead of and/or in additionto detecting the forces applied to the joystick 5006.

The handpiece 5002 also includes a shaft 5016 extending distally fromthe elongate body 5004. The shaft 5016 is rotatably coupled to theelongate body 5004. For example, a rotary joint 5018 intermediate theelongate body 5004 and the shaft 5016 can permit rotation of the shaft5016 in the directions R_(s) shown in FIG. 57 . The rotary joint 5018can include journaled shafts and/or rotary bearings, for example. Theelongate body 5004 also includes a rotary sensor 5020 (FIG. 59A), whichis configured to detect rotary displacement of the shaft 5016 relativeto the elongate body 5004. The rotary sensor 5020 can be a rotaryforce/torque sensor and/or transducer, rotary strain gauge, strain gaugeon a spring, rotary encoder, and/or an optical sensor to detect rotarydisplacements at the rotary joint 5018, for example.

The shaft 5016 also includes a radial sensor 5022 (FIG. 59A), which isconfigured to detect radial input forces to the shaft 5016. For example,the radial sensor 5022 can detect squeezing or pinching forces appliedto the shaft 5016 in the directions S_(s1) and S_(s2) depicted in FIG.57 . As further described herein, the forces detected by the radialsensor 5022 can correspond to input control motions to manipulate one ormore jaws of a robotic surgical tool controlled by the input controldevice 5000. For example, applying a pinching force in the directionsS_(s1) and S_(s2) can be configured to applying a jaw clamping motion atthe jaws of the robotic surgical tool, such as to close the opposingjaws 1054 of the robotic surgical tool 1050 (FIG. 12 ).

Additionally or alternatively, the handpiece 5002 can include anactuation trigger pivotably coupled to the elongate body 5004. Theactuation trigger can be movable between an unactuated position and oneor more actuated positions. The handpiece 5002 can also include atrigger sensor configured to detect the actuation of the trigger. Invarious instances, actuation of the trigger can correspond to closuremotions for one or more jaws of the robotic surgical tool 1050 (FIG. 12), for example. For example, the trigger sensor can be communicativelycoupled to the control circuit 5048 for the input control device 5000.Output control signals can be relayed to the robotic surgical systembased on the actuation of the trigger as detected by the trigger sensor.A pivotable trigger on the input control device 5000 can provide anintuitive mechanism for certain surgeons who are accustomed to usinghandheld surgical instruments having a trigger for closing the jaws ofthe end effector.

The handpiece 5002 also includes a body sensor 5030 (FIG. 59A), which isembedded in the elongate body 5004 and configured to detect motion ofthe elongate body 5004 in three-dimensional space. The body sensor 5030is a motion sensor. For example, the body sensor 5030 can be an inertiasensor, for example. The inertia sensor can include an accelerometerand/or gyroscope, for example, to detect the effect of gravity on themoving elongate body 5004. In other instances, the body sensor 5030 canbe an electromagnetic tracking receiver, which is configured to detectelectromagnetic forces emitted from a source in the vicinity of thehandpiece 5002 (e.g. an emitter within the operating room or surgicaltheater). The body sensor 5030 can be configured to detect input motionsin multiple dimensions, such as displacement along the X, Y, and Z axesin FIG. 57 and input rotations in multiple dimensions, such as themoments R, P and T about the X, Y, and Z axes, respectively, in FIG. 57.

The handpiece 5002 also includes a button 5026 on the elongate body5004. The button 5026 can be positioned and dimensioned such that asurgeon holding the elongate body 5004 can manipulate the button 5026with one of his or her fingers, such as a middle finger (M), ring finger(R), and/or littler finger (L) in the position shown in FIG. 60 . Invarious instances, the button 5026 can selectively unlock or unlockcertain input control motions via the input control device 5000. Forexample, upon activation of the button 5026, input control motionsdetected by the body sensor 5030 can be utilized to control the roboticsurgical tool. In certain instances, the input control motions detectedby the body sensor 5030 can only be output to control the roboticsurgical tool while a series of requisite conditions are met, includingthe activation of the button 5026. In other instances, activation of thebutton 5026 can override the default operational mode conditions andcorresponding input control functions of the input control device 5000.For example, activation of the button 5026 can enable a precision motionmode though a requisite condition has not yet been met, such as beforethe proximity detection system detects the surgical tool beingpositioned within the threshold proximity of tissue. The button 5026 canbe activated by depressing the button 5026 toward the elongate body5004, which may be spring-loaded away from the elongate body 5004. Asensor 5032 (FIG. 59A) in the elongate body 5004 can be configured todetect the activation and deactivation of the button 5026.

Although one actuation button 5026 is shown on the handpiece 5002, thereader will appreciate that additional actuation buttons can bepositioned on the elongate body 5004. Each actuation button cancorrespond to different functions, such as different control functionsfor supplying input control motions via the input control device 5000and/or different surgical functions performed by the end effector, forexample. Moreover, the reader will appreciate that the actuation button5026 and/or additional actuation buttons on the handpiece 5002 can havea different geometry and/or structure, and can include a trigger, abutton, a switch, a lever, a toggle, and combinations thereof.

Control logic for the input control device 5000 can be utilized in thecontrol circuit 5048, which is schematically depicted in FIG. 59A. Thereader will appreciate that the control circuit 832 (FIG. 25 ), thecontrol circuit 1400 (FIG. 11C), the combinational logical circuit 1410(FIG. 11D), and/or the sequential logic circuit 1420 (FIG. 11E), forexample, can also be configured to implement control logic for the inputcontrol device 5000 in certain instances. Referring again to the controlcircuit 5048, a processor 5050, a memory 5052, and the power source 5054are included within the housing of the handpiece 5002. The power source5054 can be a battery or battery pack, which can be replaceable and/orrechargeable in certain instances. The power source 5054 is configuredto supply current to the various powered components in the handpiece5002. The memory 5052 stores instructions, which are executable by theprocessor 5050, to implement the control logic for the input controldevice 5000. For example, the memory 5052 can store the thresholdproximity value and/or incremental proximity values for implementing thecontrol logic further described herein.

The control circuit 5048 also includes the communication module 5056coupled to the processor 5050. The communication module 5056 cancommunicatively couple the processor 5050 to a proximity detectionsystem 5060, which is configured to detect a proximity between therobotic surgical tool controlled by the input control device 5000 andtissue. The proximity detection system 5060 includes a structured lightsource, such as the structured light source 852 in FIG. 25 , forexample. In other instances, the proximity detection system 5060 canrely on Lidar and/or time-of-flight distance determining systems todetermine the proximity between the robotic surgical tool and thetissue. Alternative proximity detection systems that are compatible withthe control circuit 5048 are further described herein.

The processor 5050 is configured to receive proximity signals from theproximity detection system 5060 and receive input control signals fromthe sensors of the input control device 5000, including the multi-axisforce sensor 5010, the rotary sensor 5020, the radial sensor 5022, thebody sensor 5030 and the sensor 5032 for the button 5026, for example.In response to the processor 5050 receiving a proximity signalindicating that the proximity to tissue has been reduced to less than athreshold value, the processor is configured to switch the input controldevice 5000 between a first mode, which can be the gross motion mode,and a second mode, which can be the precision motion mode (see, e.g. thecontrol logic 1068 in FIG. 11A).

In the gross motion mode, the processor 5050 is configured to provideoutput control signals to the robotic surgical tool based on the inputcontrol forces supplied to the joystick 5006 and detected by themulti-axis force sensor 5010. For example, the surgeon can apply forcesto the joystick 5006 with his or her thumb (T) (FIGS. 60 and 61 ), whichcan correspond to input control motions for moving the robotic surgicaltool in three-dimensional space. In certain instances, control motionsapplied to the joystick 5006 and detected by the multi-axis force sensor5010 in the gross motion mode can drive the robotic surgical tool in thedesired direction. In such instances, the input control device 5000 candrive the robotic surgical tool toward tissue and across large distanceswithout requiring displacements of the input control device 5000 andwithout requiring a clutch to maintain the input control device within awork envelope. In various instances, rotation and/or articulationfunctions of the robotic surgical tool can be selectively locked outduring the gross motion mode.

In the precision motion mode, the processor 5050 can provide outputcontrol signals to the robotic surgical tool based on the input controlmotions applied to the elongate body 5004 and detected by the bodysensor 5030. For example, the surgeon can move the handpiece 5002 inthree-dimensional space and the motion can be detected by the bodysensor 5030, which can correspond to input control motions for movingthe robotic surgical tool in three-dimensional space. In variousinstances, displacement of the robotic surgical tool and articulation ofthe surgical tool in three-dimensional space (e.g. pitching and yawmotions of the end effector) can be activated by the detection of suchrotational movement by the body sensor 5030 during the precision motionmode. In the precision motion mode, the joystick 5006 and/or themulti-axis force sensor 5010 can be deactivated and/or the input controlforces detected by the multi-axis force sensor 5010 can be ignored.Furthermore, in the precision motion mode, rolling motions of the endeffector (e.g. rolling about the longitudinal shaft axis of the roboticsurgical tool) can be generated by rolling the shaft 5016 in thedirections R_(s) (FIG. 57 ), for example, and actuations of the endeffector (e.g. closing of the jaws) can be generated by pinching forcesapplied to the shaft 5016 in the directions S_(s1) and S_(s2), forexample.

In various aspects, the input control motions applied to the inputcontrol device 5000 in the precision motion mode can correspond to equalmotions of the robotic surgical tool. For example, displacement of thehandpiece 5002 in three-dimensional space can correspond to an equaldisplacement of the robotic surgical tool. In other words, the controlinput motions can have a one-to-one correlation to the robotic surgicaltool motions, which can provide an intuitive control system for thesurgeon. In other instances, the control motions in the precision modecan be scaled.

In certain instances, input motions applied to the handpiece 5002 can beselectively ignored by the processor 5050 and/or not converted to outputcontrol signals for controlling the robotic surgical tool. For example,before the proximity detected by the proximity detection system 5060reaches the threshold proximity (i.e. when operating in the gross motionmode), the body sensor 5030 can be deactivated and/or the input controlmotions detected by the body sensor 5030 can be ignored. To control therobotic surgical tool in the gross motion mode, the surgeon can applyinput control forces to the joystick 5006. In other instances, thesurgeon can utilize the body sensor 5030 to supply control motions tothe robotic surgical tool even in the gross motion mode and beforereaching the threshold proximity by selectively activating the button5026 to override the default rules of the control logic.

Referring now to FIG. 62 , a hypothetical graphical representation 5070of input control sensitivity relative to tissue proximity for the inputcontrol device 5000 is shown. The control logic for the input controldevice 5000 can be configured to scale the output control signals in thegross motion mode in response to the proximity signals received from theproximity detection system 5060. For example, in a gross motion mode5071, forces detected by the multi-axis force sensor 5010 can be scaledin response to approaching the threshold proximity (D_(critical)). Morespecifically, the gross motion mode 5071 can enable the robotic surgicaltool to selectively move at relatively high speeds in a region 5072, inwhich the multi-axis force sensor 5010 is highly sensitive to inputcontrol forces applied by the surgeon.

Upon reaching a first distance with respect to tissue (Di), thesensitivity of the multi-axis force sensor 5010 can begin to decrease,which can reduce the speed of the robotic surgical tool as it approachestissue. In certain instance, the decrease in sensitivity with respect totissue proximity can define one or more curved and/or linearrelationships. In still other instances, the decrease can define anincremental and/or stepped profile. The sensitivity can decrease in theregion 5074 until the threshold proximity (D_(critical)) is met, atwhich time the input control device 5000 enters the precision motionmode 5075 and the sensitivity is zero. According to the default rules ofthe control logic, in the precision motion mode 5075, input controlforces at the multi-axis force sensor 5010 do not control displacementof the robotic surgical tool.

In certain instances, the joystick 5006 and the multi-axis force sensor5010 (FIG. 59A) can be disabled throughout the surgical procedure,including during a gross motion mode, for example. In such instances,the surgeon can selectively operate the input control device 5000 byrelying entirely on the body sensor 5030 (FIG. 59A) when the joystick5006 and/or multi-axis force sensor 5010 are disabled.

In various instances, the surgeon can supply rolling input controlmotions to the shaft 5016 in the gross motion mode and the precisionmotion mode. In other instances, rotation of the shaft 5016 can beselectively locked out and/or rolling input control motions to the shaft5016 can be selectively ignored by the control circuit 5048 during oneor more portions of a surgical procedure, such as during the grossmotion mode, for example. Additionally or alternatively, in certaininstances, applying opening and/or closing motions to the jaws of asurgical end effector can be selectively locked out and/or ignored bythe control circuit 5048 during one or more portions of the surgicalprocedure, such as during the gross motion mode, for example.

In various aspects of the present disclosure, an untethered, ungroundedinput control device can utilize a motion capture system to control arobotic surgical tool, such as the robotic surgical tool 1050 (FIG. 12), in multiple operational modes including a precision motion mode and agross motion mode. Moreover, in certain aspects of the presentdisclosure, an input control device may not include a gross modeactuator and sensor, like the joystick 5006 and the multi-axis forcesensor 5010, for example. In such instances, the surgeon can selectivelyoperate the input control device 5000 by relying entirely on a motioncapture system, as further described herein.

Referring now to FIGS. 63-67 , an untethered, ungrounded input controldevice 5100 is shown. The input control device 5100 can be incorporatedinto a surgical system, such as the surgical system 110 (FIG. 1 ) or thesurgical system 150 (FIG. 3 ), for example, to provide control signalsto a surgical robot and/or surgical tool coupled thereto. The inputcontrol device 5100 includes manual input controls for moving therobotic arm and/or the surgical tool in three-dimensional space. Theinput control device 5100 is similar to the input control device 5000 inmany respects. For example, the input control device 5100 includessufficient degrees of freedom to control the robotic surgical tool 1050shown in FIG. 12 . The input control device 5100 also includes ahandpiece 5102 that is similar to the handpiece 5002 in many respects.For example, the handpiece 5102 is wireless and includes a power sourceand a control circuit having wireless communication capabilities withexternal components, similar to the control circuit 5048 (FIG. 59A) inmany respects. The handpiece 5102 includes an elongate body 5104 thatthe surgeon can comfortably grasp during use. The input control device5100 includes the shaft 5016, which is rotatably coupled to the elongatebody 5104, at the rotary joint 5018 and includes a rotary sensor (e.g.the rotary sensor 5020 in FIG. 59A) configured to detect rotarydisplacement of the shaft 5016 relative to the elongate body 5104.Additionally, the shaft 5016 can include a radial sensor (e.g. theradial sensor 5022 in FIG. 59A). In other instances, the input controldevice 5100 can include an actuation trigger and corresponding triggersensor for applying opening and/or closing motions to jaws of therobotic surgical tool, as further described herein with respect to FIGS.57-61 .

Unlike the input control device 5000, the input control device 5100 doesnot include a joystick and multi-axis force sensor coupled thereto.Rather, control input motions for moving a robotic surgical tool inthree-dimensional space are controlled by a motion capture system in thegross motion mode and the precision motion mode. The handpiece 5102includes a body sensor, like the body sensor 5030 in FIG. 59A, which isembedded in the elongate body 5104 and configured to detect motion ofthe elongate body 5104 in three-dimensional space. The handpiece 5102also includes a button 5126 on the elongate body 5104 and a buttonsensor, which are similar to the button 5026 (FIGS. 57-61 ) and thesensor 5032 (FIG. 59A) in many respects.

The control functions of the input control device 5100 can depend on theposition of the input control device 5100 relative to a home positionand a zone surrounding the home position. The position of the inputcontrol device 5100 relative to the home position and the surroundingzone can be determined by the motion capture system thereof. Ahypothetical gross motion zone 5140 is shown in FIG. 63 . The grossmotion zone 5140 is a three-dimensional volume having a boundary or edge5142 therearound. The gross motion zone 5140 can be defined with respectto the home position. The home position can be set or established by thesurgeon's input (e.g. by actuating the button 5126 or another actuatoron the handpiece 5102). The home position of the input control device5100 can be a central position equidistantly-spaced from all of theboundaries 5142 of the gross motion zone 5140. In various instances,from the home position, the boundaries 5142 can be positioned about 2inches to about 6 inches from the home position. In other instances, theboundaries 5142 can be positioned less than 2 inches or more than 6inches from the home position in at least one direction. Although thegross motion zone in FIG. 63 defines a cylindrical shape, the readerwill appreciate that alternative geometries can be employed.

In various instances, in the gross motion mode, the surgeon can drive arobotic surgical tool in a particular direction by moving the inputcontrol device 5100 in the corresponding direction away from the homeposition. As the input control device 5100 approaches the boundary oredge of the gross motion zone 5140, the speed of the robotic surgicaltool driven by the input control device 5100 can increase. The grossmotion mode can be maintained by holding down the button 5126, forexample. In various instances, to initiate the gross motion mode, thesurgeon can engage the button 5126 which defines or sets the homeposition within the gross motion zone, and can drive the roboticsurgical tool in the gross motion mode as long as the button 5126remains engaged and/or actuated.

Referring now to FIG. 68 , the input control device 5100 can utilizecontrol logic that correlates the distance of the input control device5100 from the home position with respect to the speed of the roboticsurgical tool driven by the input control device 5100. Control logic forthe input control device 5100 can be utilized in the control circuit 832(FIG. 25 ), the control circuit 1400 (FIG. 11C), the combinationallogical circuit 1410 (FIG. 11D), and/or the sequential logic circuit1420 (FIG. 11E), for example, where an input is provided from inputs tothe input control device 4000 and/or a surgical visualization system ordistance determining subsystem thereof, as further described herein. Asthe distance of the input control device 5100 from the home positionincreases in FIG. 68 , the speed of the robotic surgical tool driven bythe input control device 5100 can be increasingly scaled toward themaximum speed. When the input control device 5100 meets and/or exceedsthe boundary 5142 of the gross motion zone 5140 (e.g. leaves the grossmotion zone 5140), the high speed of the robotic surgical tool can bemaintained in the gross motion mode. In various instances, retractingthe input control device 5100 toward the home position within the grossmotion zone 5140 can correspondingly decrease the speed of the roboticsurgical tool.

When the proximity of the robotic surgical tool meets the threshold orcritical proximity stored in the memory and accessible to the controllogic, the input control device 5100 can switch from the gross motionmode to the precision motion mode. In the precision motion mode,movement of the robotic surgical tool can be controlled by the sameinput controls described herein with respect to FIGS. 57-62 . Forexample, input control motions detected by the body sensor of the motioncapture system can control three-dimensional displacement of the roboticsurgical tool and pivoting of the robotic surgical tool inthree-dimensional space, such a pitching and yaws articulation motionsof the end effector. Additionally, rotation of the shaft 5016 cancontrol the rolling motion of the end effector, and pinching forces tothe shaft 5016 can control the opening and/or closing of one or morejaws of the end effector.

In various aspects, the input control motions applied to the inputcontrol device 5100 in the precision motion mode can correspond to equalmotions of the robotic surgical tool. For example, displacement of thehandpiece 5102 in three-dimensional space can correspond to an equaldisplacement of the robotic surgical tool. In other words, the controlinput motions can have a one-to-one correlation to the robotic surgicaltool motions, which can provide an intuitive control system for thesurgeon. In other instances, the control motions in the precision modecan be scaled.

Examples

Various aspects of the subject matter described herein are set out inthe following numbered examples.

A list of Examples follows:

-   -   Example 1—A control system for a surgical robot, the control        system comprising a base, a central portion flexibly supported        by the base, a wrist longitudinally offset from the central        portion and rotationally coupled to the central portion, a        multi-axis sensor arrangement configured to detect user input        forces applied to the central portion, a rotary sensor        configured to detect user input motions applied to the wrist, a        memory, and a processor communicatively coupled to the memory.        The processor is configured to receive a plurality of first        input signals from the multi-axis sensor arrangement, provide a        plurality of first output signals to the surgical robot based on        the plurality of first input signals, receive a plurality of        second input signals from the rotary sensor, and provide a        plurality of second output signals to the surgical robot based        on the plurality of second input signals.    -   Example 2—The control system of Example 1, wherein the plurality        of first input signals correspond to forces and moments applied        to the central portion in three-dimensional space.    -   Example 3—The control system of Examples 1 or 2, wherein the        plurality of first output signals correspond to translation and        rotation of a surgical tool coupled to the surgical robot.    -   Example 4—The control system of any one of Examples 1-3, wherein        the plurality of second input signals correspond to rotational        displacement of the wrist relative to the base in        three-dimensional space.    -   Example 5—The control system of Examples 3 or 4, wherein the        plurality of second output signals correspond to a rolling        motion of the surgical tool.    -   Example 6—The control system of any one of Examples 1-5, wherein        the central portion comprises a joystick. A shaft extends        between the joystick and the wrist.    -   Example 7—The control system of any one of Examples 1-6, further        comprising a jaw movably supported on the wrist and a jaw sensor        configured to detect movement of the jaw. The jaw is movable        between an open configuration and a clamped configuration. The        processor is further configured to receive a plurality of third        input signals from the jaw sensor and provide a plurality of        third output signals to the surgical robot indicative of an        actuation motion of a jaw member of a surgical tool coupled to        the surgical robot.    -   Example 8—A control system for a surgical robot, the control        system comprising a first control input comprising a        flexibly-supported joystick, a memory, and a control circuit        communicatively coupled to the memory. The memory stores        instructions executable by the control circuit to switch the        control system between a first mode and a second mode, receive a        plurality of first input signals from the first control input,        scale the plurality of first input signals by a first multiplier        in the first mode, and scale the plurality of first input        signals by a second multiplier in the second mode. The second        multiplier is different than the first multiplier.    -   Example 9—The control system of Example 8, wherein the        flexibly-supported joystick is operably coupled to a multi-axis        force and torque sensor configured to detect forces and moments        applied to the flexibly-supported joystick. The plurality of        first input signals correspond to output signals from the        multi-axis force and torque sensor.    -   Example 10—The control system of Examples 8 or 9, wherein the        first mode corresponds to a gross motion mode and the second        mode corresponds to a precision motion mode.    -   Example 11—The control system of any one of Examples 8-10,        wherein the control circuit is communicatively coupled to a        proximity detection system. The control circuit is further        configured to receive a proximity signal from the proximity        detection system and switch the control system from the first        mode to the second mode when the proximity signal corresponds to        a proximity less than a threshold value.    -   Example 12—The control system of any one of Examples 8-11,        further comprising a second control input comprising a rotatable        wrist. The control circuit is further configured to receive a        plurality of second input signals from the second control input,        scale the plurality of second input signals by a third        multiplier in the first mode, and scale the plurality of second        input signals by a fourth multiplier in the second mode. The        fourth multiplier is different than the third multiplier.    -   Example 13—The control system of Example 12, further comprising        a rotary sensor configured to detect rotation of the rotatable        wrist. The plurality of second input signals correspond to        output signals from the rotary sensor.    -   Example 14—The control system of Examples 12 or 13, further        comprising a shaft extending from the flexibly-supported        joystick. The rotatable wrist is configured to rotate on the        shaft.    -   Example 15—The control system of Example 14, further comprising        a pair of opposing actuators pivotably supported on the shaft        and a sensor configured to detect pivoting movement of the pair        of opposing actuators.    -   Example 16—A control system for a surgical robot, the control        system comprising a first input comprising a flexibly-supported        joystick and a multi-axis force and torque sensor arrangement        configured to detect user input forces and torques applied to        the flexibly-supported joystick, a second input comprising a        rotary joint and a rotary sensor configured to detect user input        motions applied to the rotary joint, and a control unit. The        control unit is configured to provide a first plurality of        output signals to the surgical robot based on actuation of the        first input and provide a second plurality of output signals to        the surgical robot based on actuation of the second input.    -   Example 17—The control system of Example 16, wherein the        flexibly-supported joystick is spring-biased to an upright        position.    -   Example 18—The control system of Examples 16 or 17, wherein the        control unit is communicatively coupled a proximity detection        system. The control unit is further configured to receive a        proximity signal from the proximity detection system, scale the        user input forces and torques detected by the multi-axis force        and torque sensor arrangement by a first factor when the        proximity signal is greater than a threshold value, and scale        the user input forces and torques detected by the multi-axis        force and torque sensor arrangement by a second factor when the        proximity signal is equal to or less than the threshold value.        The second factor is different than the first factor.    -   Example 19—The control system of Example 18, wherein the second        factor is less than the first factor.    -   Example 20—The control system of Examples 18 or 19, wherein the        control unit is further configured to ignore the user input        motions applied to the rotary joint when the proximity signal is        greater than a critical value.

Another list of Examples follows:

-   -   Example 1—A control system comprising a robotic surgical tool, a        tissue proximity detection system configured to intraoperatively        detect a distance between the robotic surgical tool and an        anatomical structure, and a user input device. The user input        device comprises a base comprising a force sensor, a forearm        support movably coupled to the base, a shaft extending distally        from the forearm support, a handpiece extending distally from        the shaft, and a jaw sensor configured to detect pivotal        movement of the jaw. The forearm support is movable relative to        the base within a travel zone and the handpiece comprises a jaw.        The forearm support, the shaft, and the handpiece are movable        together as a collective unit as the forearm support moves        relative to the base within the travel zone. The user input        device further comprises a displacement sensor configured to        detect movement of the collective unit. The control system        further comprises a control circuit communicatively coupled to        the force sensor, the displacement sensor, and the jaw sensor.        The control circuit is configured to receive first input signals        from the force sensor, receive second input signals from the        displacement sensor, receive third input signals from the jaw        sensor, and switch the user input device from a first mode to a        second mode in response to input from the tissue proximity        detection system indicative of the distance between the robotic        surgical tool and the anatomical structure being reduced to less        than a threshold distance. The first input signals control        movements of the robotic surgical tool in the first mode and the        second input signals and the third input signals control        movements of the robotic surgical tool in the second mode.    -   Example 2—The control system of Example 1, wherein the travel        zone comprises a three-dimensional space surrounding a forearm        home position. The forearm support is spring-biased toward the        forearm home position and the three-dimensional space extends in        all directions between 2.0 cm and 6.0 cm from the forearm home        position.    -   Example 3—The control system of Examples 1 or 2, wherein the        forearm support comprises a curved arc forming a cuff and the        cuff is dimensioned to at least partially surround a surgeon's        arm.    -   Example 4—The control system of any one of Examples 1-3, wherein        the tissue proximity detection system comprises a structured        light source on the robotic surgical tool.    -   Example 5—A control system comprising a tissue proximity        detection system and a user input device. The user input device        comprises a base, a forearm support movably coupled to the base,        a shaft extending distally from the forearm support, a handpiece        extending distally from the shaft, and a plurality of sensors.        The forearm support is movable relative to the base within a        travel zone and the handpiece comprises a jaw configured to        pivot relative to the shaft. The plurality of sensors comprises        a first sensor arrangement configured to detect user input        forces to the base, a second sensor arrangement configured to        detect displacement of the forearm support, and a third sensor        arrangement configured to detect pivotal motion of the jaw. The        control system further comprises a control circuit configured to        receive proximity data signals from the tissue proximity        detection system, receive first input signals from the first        sensor arrangement, receive second input signals from the second        sensor arrangement, receive third input signals from the third        sensor arrangement, and switch the user input device from a        first mode to a second mode in response to proximity data        signals from the tissue proximity detection system indicating a        predefined tissue proximity. The first input signals control        movements of the robotic surgical tool in the first mode and the        second input signals and the third input signals control        movements of the robotic surgical tool in the second mode.    -   Example 6—A user input device for controlling a robotic surgical        tool, the user input device comprising a base comprising a first        sensor arrangement and a forearm support movably coupled to the        base. The forearm support is movable relative to the base within        a travel zone and the forearm support comprises a second sensor        arrangement. The user input device further comprises a control        circuit configured to receive first input signals from the first        sensor arrangement, receive second input signals from the second        sensor arrangement, and switch the user input device between a        first mode, in which the first input signals control movements        of the robotic surgical tool, and a second mode, in which the        second input signals control movements of the robotic surgical        tool.    -   Example 7—The user input device of Example 6, wherein the        control circuit is communicatively coupled to a tissue proximity        detection system. The control circuit is configured to switch        the user input device between the first mode and the second mode        in response to input from the tissue proximity detection system.    -   Example 8—The user input device of Example 7, wherein the first        mode comprises a gross motion mode and the second mode comprises        a precision motion mode. The control circuit is configured to        switch the user input device between the gross motion mode and        the precision motion mode when the tissue proximity detection        system provides a proximity signal indicative of the robotic        surgical tool being positioned less than a threshold distance        from an anatomical structure.    -   Example 9—The user input device of any one of Examples 6-8,        wherein the first sensor arrangement comprises a six        degree-of-freedom force and torque sensor.    -   Example 10—The user input device of any one of Examples 6-9,        wherein the first sensor arrangement comprises a joystick        movable in a three-dimensional space around an input home        position. The three-dimensional space extends in all directions        between 1.0 mm and 5.0 mm from the input home position and the        joystick is spring-biased toward the input home position.    -   Example 11—The user input device of any one of Examples 6-10,        wherein the second sensor arrangement comprises a displacement        sensor.    -   Example 12—The user input device of any one of Examples 6-11,        wherein the travel zone comprises a three-dimensional space        surrounding a forearm home position and the forearm support is        spring-biased toward the forearm home position.    -   Example 13—The user input device of Example 12, wherein the        three-dimensional space extends in all directions between 2.0 cm        and 6.0 cm from the forearm home position.    -   Example 14—The user input device of any one of Examples 6-13,        wherein the forearm support comprises a curved arc forming a        sleeve and the sleeve is dimensioned to at least partially        surround a surgeon's arm.    -   Example 15—The user input device of any one of Examples 6-14,        further comprising a shaft extending distally from the forearm        support, a handpiece extending distally from the shaft and        comprising a first jaw and a second jaw, and a jaw sensor        arrangement configured to detect pivotal motion of the first jaw        and the second jaw within the range of motion. The first jaw and        the second jaw are pivotable relative to the shaft within a        range of motion,    -   Example 16—The user input device of Example 15, wherein the jaw        sensor arrangement is communicatively coupled to the control        circuit. The control circuit is further configured to receive        third input signals from the jaw sensor arrangement and provide        output signals to the robotic surgical tool to control actuation        of one or more jaws of an end effector of the robotic surgical        tool.    -   Example 17—The user input device of Examples 15 or 16, further        comprising a first finger loop on the first jaw positioned and        dimensioned to receive at least one digit of a surgeon's hand        and a second finger loop on the second jaw positioned and        dimensioned to receive at least one digit of the surgeon's hand.    -   Example 18—The user input device of any one of Examples 15-17,        further comprising a rotary joint intermediate the handpiece and        the shaft and a rotary sensor configured to detection rotary        motion of the handpiece relative to the shaft.    -   Example 19—The user input device of any one of Examples 15-18,        wherein the handpiece further comprises an actuator        communicatively coupled to the control circuit. The control        circuit is further configured to receive input actuation signals        from the actuator and provide output actuation signals to the        robotic surgical tool to actuate a surgical function.    -   Example 20—The user input device of Example 19, wherein the        actuator is selected from a group consisting of a trigger, a        button, a switch, a lever, a toggle, and combinations thereof.

Another list of Examples follows:

-   -   Example 1—A control system for a robotic surgical tool, the        control system comprising an untethered handpiece comprising a        body, a joystick extending from the body, a rotatable shaft        extending from the body, and a plurality of sensors comprising a        body sensor embedded in the body and configured to detect motion        of the body in three-dimensional space, a multi-axis force        sensor configured to detect forces applied to the joystick, and        a shaft sensor configured to detect rotary displacement of the        shaft relative to the body. The control system further comprises        a control circuit communicatively coupled to the plurality of        sensors and a proximity detection system. The control circuit is        configured to receive proximity signals from the proximity        detection system, receive input control signals from the        plurality of sensors, switch between a gross motion mode and a        precision motion mode in response to receiving a proximity        signal indicating the proximity being reduced to less than a        threshold value, provide gross motion control signals to the        robotic surgical tool based on the input control signals from        the multi-axis force sensor in the gross motion mode, and        provide precision motion control signals to the robotic surgical        tool based on the input control signals from the body sensor and        the shaft sensor in the precision motion mode. The proximity        signals are indicative of a proximity of the robotic surgical        tool to tissue.    -   Example 2—The control system of Example 1, wherein the joystick        comprises a loop dimensioned and positioned to receive a user's        thumb.    -   Example 3—The control system of Examples 1 or 2, wherein the        body sensor is selected from a group consisting of an inertial        sensor and an electromagnetic tracking receiver.    -   Example 4—The control system of any one of Examples 1-3, wherein        the shaft sensor is selected from a group consisting of a rotary        transducer, strain gauge, and an optical sensor.    -   Example 5—A control system for a robotic surgical tool, the        control system comprising an untethered handpiece comprising a        body, an actuator extending from the body, a rotatable shaft        extending from the body, and a plurality of sensors comprising a        body sensor embedded in the body and configured to detect motion        of the body in three-dimensional space, a force sensor        configured to detect forces applied to the actuator, and a shaft        sensor configured to detect rotary displacement of the shaft        relative to the body. The control system further comprises a        proximity detection system configured to detect a proximity of        the robotic surgical tool to tissue and a control circuit        communicatively coupled to the plurality of sensors and the        proximity detection system. The control circuit is configured to        receive proximity signals from the proximity detection system,        receive input control signals from the plurality of sensors,        switch between a first mode and a second mode in response to        receiving a proximity signal indicating the proximity being        reduced to less than a threshold value, provide first motion        control signals to the robotic surgical tool based on the input        control signals from the force sensor in the first mode, and        provide second motion control signals to the robotic surgical        tool based on the input control signals from the body sensor and        the shaft sensor in the second mode. The proximity signals are        indicative of the proximity of the robotic surgical tool to        tissue and the first motion control signals are scaled based on        the proximity signal.    -   Example 6—The control system of Example 5, wherein the proximity        detection system comprises a structured light source and an        optical receiver.    -   Example 7—The control system of Examples 5 or 6, wherein the        shaft further comprises a radial sensor configured to detect        radial forces applied to the shaft. The control circuit is        further configured to receive input control signals from the        radial sensor and provide output control signals to the robotic        surgical tool based on the input control signals from the radial        sensor. The output control signals are configured to apply        closure motions to one or more jaws of the robotic surgical        tool.    -   Example 8—A control system for a robotic surgical tool, the        control system comprising an untethered handpiece comprising a        body, an actuation arm extending proximally from the body, a        shaft extending distally from the body, and a plurality of        sensors comprising a body sensor embedded in the body and        configured to detect motion of the body in three-dimensional        space, an arm sensor configured to detect forces applied to the        actuation arm, and a shaft sensor configured to detect rotary        displacement of the shaft relative to the body. The control        system further comprises a control circuit communicatively        coupled to the plurality of sensors and a proximity detection        system. The control circuit is configured to receive proximity        signals from the proximity detection system, receive input        control signals from the plurality of sensors, switch between a        gross motion mode and a precision motion mode in response to        receiving a proximity signal indicating the proximity being        reduced to less than a threshold value, provide output control        signals to the robotic surgical tool based on the input control        signals from the arm sensor in the gross motion mode, and        provide output control signals to the robotic surgical tool        based on the input control signals from the body sensor and the        shaft sensor in the precision motion mode. The proximity signals        are indicative of a proximity of the robotic surgical tool to        tissue.    -   Example 9—The control system of Example 8, wherein the actuation        arm comprises a joystick movably coupled to the body at a space        joint.    -   Example 10—The control system of Example 9, wherein the joystick        comprises a ring dimensioned and positioned to receive a user's        thumb.    -   Example 11—The control system of Examples 9 or 10, wherein the        arm sensor comprises a multi-axis force sensor positioned at the        space joint.    -   Example 12—The control system of any one of Examples 8-11,        wherein the body sensor comprises an inertial sensor.    -   Example 13—The control system of any one of Examples 8-11,        wherein the body sensor comprises an electromagnetic tracking        receiver.    -   Example 14—The control system of any one of Examples 8-13,        wherein the proximity detection system comprises a structured        light source.    -   Example 15—The control system of any one of Examples 8-14,        wherein the control circuit is further configured to scale the        output control signals based on the input control signals        received by the arm sensor in the gross motion mode in response        to the proximity signals received from the proximity detection        system.    -   Example 16—The control system of Example 15, wherein the control        circuit is further configured to reduce the output control        signals in the gross motion mode in response to the proximity        signals indicating the robotic surgical tool is approaching        tissue.    -   Example 17—The control system of any one of Examples 8-16,        wherein the untethered handpiece further comprises a lock for        the actuation arm. The lock is movable from an unlocked position        to a locked position in response to receiving the proximity        signal indicating the proximity being reduced to less than the        threshold value.    -   Example 18—The control system of any one of Examples 8-17,        wherein the body further comprises a spring-loaded actuation        button movable between an initial position and a depressed        position. The output control signals based on the input control        signals detected by the body sensor in the gross motion mode are        only provided to the robotic surgical tool when the        spring-loaded actuation button is moved to the depressed        position.    -   Example 19—The control system of any one of Examples 8-18,        wherein the shaft further comprises a radial sensor configured        to detect radial forces applied to the shaft. The control        circuit is further configured to receive input control signals        from the radial sensor and provide output control signals to the        robotic surgical tool based on the input control signals from        the radial sensor to apply closure motions to one or more jaws        of the robotic surgical tool.    -   Example 20—The control system of any one of Examples 8-19,        wherein the untethered handpiece further comprises a trigger and        a trigger sensor configured to detect an actuation of the        trigger. The control circuit is further configured to receive        input control signals from the trigger sensor and provide output        control signals to the robotic surgical tool based on the input        control signals from the trigger sensor to apply closure motions        to one or more jaws of the robotic surgical tool.    -   Example 21—A control system for a robotic surgical tool, the        control system comprising an untethered handpiece comprising a        gross motion controller comprising a multi-axis sensor, a        precision motion controller comprising an embedded motion        sensor, and a control circuit communicatively coupled to the        multi-axis sensor, the embedded motion sensor, and a proximity        detection system. The control circuit is configured to receive        proximity signals from the proximity detection system indicative        of a proximity of the robotic surgical tool to tissue and switch        between a gross motion mode, in which input control signals from        the gross motion controller are utilized to control the robotic        surgical tool, and a precision motion mode, in which input        control signals from the precision motion controller are        utilized to control the robotic surgical tool, in response to        receiving a proximity signal indicating the proximity being        reduced to less than a threshold value.

While several forms have been illustrated and described, it is not theintention of Applicant to restrict or limit the scope of the appendedclaims to such detail. Numerous modifications, variations, changes,substitutions, combinations, and equivalents to those forms may beimplemented and will occur to those skilled in the art without departingfrom the scope of the present disclosure. Moreover, the structure ofeach element associated with the described forms can be alternativelydescribed as a means for providing the function performed by theelement. Also, where materials are disclosed for certain components,other materials may be used. It is therefore to be understood that theforegoing description and the appended claims are intended to cover allsuch modifications, combinations, and variations as falling within thescope of the disclosed forms. The appended claims are intended to coverall such modifications, variations, changes, substitutions,modifications, and equivalents.

The foregoing detailed description has set forth various forms of thedevices and/or processes via the use of block diagrams, flowcharts,and/or examples. Insofar as such block diagrams, flowcharts, and/orexamples contain one or more functions and/or operations, it will beunderstood by those within the art that each function and/or operationwithin such block diagrams, flowcharts, and/or examples can beimplemented, individually and/or collectively, by a wide range ofhardware, software, firmware, or virtually any combination thereof.Those skilled in the art will recognize that some aspects of the formsdisclosed herein, in whole or in part, can be equivalently implementedin integrated circuits, as one or more computer programs running on oneor more computers (e.g., as one or more programs running on one or morecomputer systems), as one or more programs running on one or moreprocessors (e.g., as one or more programs running on one or moremicroprocessors), as firmware, or as virtually any combination thereof,and that designing the circuitry and/or writing the code for thesoftware and or firmware would be well within the skill of one of skillin the art in light of this disclosure. In addition, those skilled inthe art will appreciate that the mechanisms of the subject matterdescribed herein are capable of being distributed as one or more programproducts in a variety of forms, and that an illustrative form of thesubject matter described herein applies regardless of the particulartype of signal bearing medium used to actually carry out thedistribution.

Instructions used to program logic to perform various disclosed aspectscan be stored within a memory in the system, such as dynamic randomaccess memory (DRAM), cache, flash memory, or other storage.Furthermore, the instructions can be distributed via a network or by wayof other computer readable media. Thus a machine-readable medium mayinclude any mechanism for storing or transmitting information in a formreadable by a machine (e.g., a computer), but is not limited to, floppydiskettes, optical disks, compact disc, read-only memory (CD-ROMs), andmagneto-optical disks, read-only memory (ROMs), random access memory(RAM), erasable programmable read-only memory (EPROM), electricallyerasable programmable read-only memory (EEPROM), magnetic or opticalcards, flash memory, or a tangible, machine-readable storage used in thetransmission of information over the Internet via electrical, optical,acoustical or other forms of propagated signals (e.g., carrier waves,infrared signals, digital signals, etc.). Accordingly, thenon-transitory computer-readable medium includes any type of tangiblemachine-readable medium suitable for storing or transmitting electronicinstructions or information in a form readable by a machine (e.g., acomputer).

As used in any aspect herein, the term “control circuit” may refer to,for example, hardwired circuitry, programmable circuitry (e.g., acomputer processor including one or more individual instructionprocessing cores, processing unit, processor, microcontroller,microcontroller unit, controller, digital signal processor (DSP),programmable logic device (PLD), programmable logic array (PLA), orfield programmable gate array (FPGA)), state machine circuitry, firmwarethat stores instructions executed by programmable circuitry, and anycombination thereof. The control circuit may, collectively orindividually, be embodied as circuitry that forms part of a largersystem, for example, an integrated circuit (IC), an application-specificintegrated circuit (ASIC), a system on-chip (SoC), desktop computers,laptop computers, tablet computers, servers, smart phones, etc.Accordingly, as used herein “control circuit” includes, but is notlimited to, electrical circuitry having at least one discrete electricalcircuit, electrical circuitry having at least one integrated circuit,electrical circuitry having at least one application specific integratedcircuit, electrical circuitry forming a general purpose computing deviceconfigured by a computer program (e.g., a general purpose computerconfigured by a computer program which at least partially carries outprocesses and/or devices described herein, or a microprocessorconfigured by a computer program which at least partially carries outprocesses and/or devices described herein), electrical circuitry forminga memory device (e.g., forms of random access memory), and/or electricalcircuitry forming a communications device (e.g., a modem, communicationsswitch, or optical-electrical equipment). Those having skill in the artwill recognize that the subject matter described herein may beimplemented in an analog or digital fashion or some combination thereof.

As used in any aspect herein, the term “logic” may refer to an app,software, firmware and/or circuitry configured to perform any of theaforementioned operations. Software may be embodied as a softwarepackage, code, instructions, instruction sets and/or data recorded onnon-transitory computer readable storage medium. Firmware may beembodied as code, instructions or instruction sets and/or data that arehard-coded (e.g., nonvolatile) in memory devices.

As used in any aspect herein, the terms “component,” “system,” “module”and the like can refer to a computer-related entity, either hardware, acombination of hardware and software, software, or software inexecution.

As used in any aspect herein, an “algorithm” refers to a self-consistentsequence of steps leading to a desired result, where a “step” refers toa manipulation of physical quantities and/or logic states which may,though need not necessarily, take the form of electrical or magneticsignals capable of being stored, transferred, combined, compared, andotherwise manipulated. It is common usage to refer to these signals asbits, values, elements, symbols, characters, terms, numbers, or thelike. These and similar terms may be associated with the appropriatephysical quantities and are merely convenient labels applied to thesequantities and/or states.

A network may include a packet switched network. The communicationdevices may be capable of communicating with each other using a selectedpacket switched network communications protocol. One examplecommunications protocol may include an Ethernet communications protocolwhich may be capable permitting communication using a TransmissionControl Protocol/Internet Protocol (TCP/IP). The Ethernet protocol maycomply or be compatible with the Ethernet standard published by theInstitute of Electrical and Electronics Engineers (IEEE) titled “IEEE802.3 Standard”, published in December, 2008 and/or later versions ofthis standard. Alternatively or additionally, the communication devicesmay be capable of communicating with each other using an X.25communications protocol. The X.25 communications protocol may comply orbe compatible with a standard promulgated by the InternationalTelecommunication Union-Telecommunication Standardization Sector(ITU-T). Alternatively or additionally, the communication devices may becapable of communicating with each other using a frame relaycommunications protocol. The frame relay communications protocol maycomply or be compatible with a standard promulgated by ConsultativeCommittee for International Telegraph and Telephone (CCITT) and/or theAmerican National Standards Institute (ANSI). Alternatively oradditionally, the transceivers may be capable of communicating with eachother using an Asynchronous Transfer Mode (ATM) communications protocol.The ATM communications protocol may comply or be compatible with an ATMstandard published by the ATM Forum titled “ATM-MPLS NetworkInterworking 2.0” published August 2001, and/or later versions of thisstandard. Of course, different and/or after-developedconnection-oriented network communication protocols are equallycontemplated herein.

Unless specifically stated otherwise as apparent from the foregoingdisclosure, it is appreciated that, throughout the foregoing disclosure,discussions using terms such as “processing,” “computing,”“calculating,” “determining,” “displaying,” or the like, refer to theaction and processes of a computer system, or similar electroniccomputing device, that manipulates and transforms data represented asphysical (electronic) quantities within the computer system's registersand memories into other data similarly represented as physicalquantities within the computer system memories or registers or othersuch information storage, transmission or display devices.

One or more components may be referred to herein as “configured to,”“configurable to,” “operable/operative to,” “adapted/adaptable,” “ableto,” “conformable/conformed to,” etc. Those skilled in the art willrecognize that “configured to” can generally encompass active-statecomponents and/or inactive-state components and/or standby-statecomponents, unless context requires otherwise.

The terms “proximal” and “distal” are used herein with reference to aclinician manipulating the handle portion of the surgical instrument.The term “proximal” refers to the portion closest to the clinician andthe term “distal” refers to the portion located away from the clinician.It will be further appreciated that, for convenience and clarity,spatial terms such as “vertical”, “horizontal”, “up”, and “down” may beused herein with respect to the drawings. However, surgical instrumentsare used in many orientations and positions, and these terms are notintended to be limiting and/or absolute.

Those skilled in the art will recognize that, in general, terms usedherein, and especially in the appended claims (e.g., bodies of theappended claims) are generally intended as “open” terms (e.g., the term“including” should be interpreted as “including but not limited to,” theterm “having” should be interpreted as “having at least,” the term“includes” should be interpreted as “includes but is not limited to,”etc.). It will be further understood by those within the art that if aspecific number of an introduced claim recitation is intended, such anintent will be explicitly recited in the claim, and in the absence ofsuch recitation no such intent is present. For example, as an aid tounderstanding, the following appended claims may contain usage of theintroductory phrases “at least one” and “one or more” to introduce claimrecitations. However, the use of such phrases should not be construed toimply that the introduction of a claim recitation by the indefinitearticles “a” or “an” limits any particular claim containing suchintroduced claim recitation to claims containing only one suchrecitation, even when the same claim includes the introductory phrases“one or more” or “at least one” and indefinite articles such as “a” or“an” (e.g., “a” and/or “an” should typically be interpreted to mean “atleast one” or “one or more”); the same holds true for the use ofdefinite articles used to introduce claim recitations.

In addition, even if a specific number of an introduced claim recitationis explicitly recited, those skilled in the art will recognize that suchrecitation should typically be interpreted to mean at least the recitednumber (e.g., the bare recitation of “two recitations,” without othermodifiers, typically means at least two recitations, or two or morerecitations). Furthermore, in those instances where a conventionanalogous to “at least one of A, B, and C, etc.” is used, in generalsuch a construction is intended in the sense one having skill in the artwould understand the convention (e.g., “a system having at least one ofA, B, and C” would include but not be limited to systems that have Aalone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). In those instances where aconvention analogous to “at least one of A, B, or C, etc.” is used, ingeneral such a construction is intended in the sense one having skill inthe art would understand the convention (e.g., “a system having at leastone of A, B, or C” would include but not be limited to systems that haveA alone, B alone, C alone, A and B together, A and C together, B and Ctogether, and/or A, B, and C together, etc.). It will be furtherunderstood by those within the art that typically a disjunctive wordand/or phrase presenting two or more alternative terms, whether in thedescription, claims, or drawings, should be understood to contemplatethe possibilities of including one of the terms, either of the terms, orboth terms unless context dictates otherwise. For example, the phrase “Aor B” will be typically understood to include the possibilities of “A”or “B” or “A and B.”

With respect to the appended claims, those skilled in the art willappreciate that recited operations therein may generally be performed inany order. Also, although various operational flow diagrams arepresented in a sequence(s), it should be understood that the variousoperations may be performed in other orders than those which areillustrated, or may be performed concurrently. Examples of suchalternate orderings may include overlapping, interleaved, interrupted,reordered, incremental, preparatory, supplemental, simultaneous,reverse, or other variant orderings, unless context dictates otherwise.Furthermore, terms like “responsive to,” “related to,” or otherpast-tense adjectives are generally not intended to exclude suchvariants, unless context dictates otherwise.

It is worthy to note that any reference to “one aspect,” “an aspect,”“an exemplification,” “one exemplification,” and the like means that aparticular feature, structure, or characteristic described in connectionwith the aspect is included in at least one aspect. Thus, appearances ofthe phrases “in one aspect,” “in an aspect,” “in an exemplification,”and “in one exemplification” in various places throughout thespecification are not necessarily all referring to the same aspect.Furthermore, the particular features, structures or characteristics maybe combined in any suitable manner in one or more aspects.

Any patent application, patent, non-patent publication, or otherdisclosure material referred to in this specification and/or listed inany Application Data Sheet is incorporated by reference herein, to theextent that the incorporated materials is not inconsistent herewith. Assuch, and to the extent necessary, the disclosure as explicitly setforth herein supersedes any conflicting material incorporated herein byreference. Any material, or portion thereof, that is said to beincorporated by reference herein, but which conflicts with existingdefinitions, statements, or other disclosure material set forth hereinwill only be incorporated to the extent that no conflict arises betweenthat incorporated material and the existing disclosure material.

In summary, numerous benefits have been described which result fromemploying the concepts described herein. The foregoing description ofthe one or more forms has been presented for purposes of illustrationand description. It is not intended to be exhaustive or limiting to theprecise form disclosed. Modifications or variations are possible inlight of the above teachings. The one or more forms were chosen anddescribed in order to illustrate principles and practical application tothereby enable one of ordinary skill in the art to utilize the variousforms and with various modifications as are suited to the particular usecontemplated. It is intended that the claims submitted herewith definethe overall scope.

What is claimed is:
 1. A control system for a surgical robot, thecontrol system comprising: a base; a central portion comprising afloating shaft flexibly supported on the base, wherein the floatingshaft comprises a first portion and a second portion, and wherein thefirst portion of the floating shaft is flexibly supported on the base; awrist longitudinally offset from the central portion by a shaft androtationally coupled to the central portion, wherein the shaft extendsfrom the second portion of the floating shaft, a multi-axis sensorarrangement configured to detect user input forces applied to thefloating shaft, wherein the floating shaft is configured to float andthe base is configured to remain stationary upon application of userinput forces; a rotary sensor configured to detect user input motionsapplied to the wrist; a memory; and a processor communicatively coupledto the memory, wherein the processor is configured to: receive aplurality of first input signals from the multi-axis sensor arrangement;provide a plurality of first output signals to the surgical robot basedon the plurality of first input signals; receive a plurality of secondinput signals from the rotary sensor; and provide a plurality of secondoutput signals to the surgical robot based on the plurality of secondinput signals.
 2. The control system of claim 1, wherein the pluralityof first input signals correspond to forces and moments applied to thecentral portion in three-dimensional space.
 3. The control system ofclaim 2, wherein the plurality of first output signals correspond totranslation and rotation of a surgical tool coupled to the surgicalrobot.
 4. The control system of claim 3, wherein the plurality of secondinput signals correspond to rotational displacement of the wristrelative to the base in three-dimensional space.
 5. The control systemof claim 4, wherein the plurality of second output signals correspond toa rolling motion of the surgical tool.
 6. The control system of claim 1,wherein the central portion comprises a joystick, and wherein the shaftextends between the joystick and the wrist.
 7. The control system ofclaim 1, further comprising: a jaw movably supported on the wrist,wherein the jaw is movable between an open configuration and a clampedconfiguration; and a jaw sensor configured to detect movement of thejaw, wherein the processor is further configured to: receive a pluralityof third input signals from the jaw sensor; and provide a plurality ofthird output signals to the surgical robot indicative of an actuationmotion of a jaw member of a surgical tool coupled to the surgical robot.8. The control system of claim 1, wherein the base is releasably securedto a fixed underlying surface, and wherein the fixed underlying surfaceis remote to the surgical robot.
 9. A control system for a surgicalrobot, the control system comprising: a base; a first clutchless controlinput comprising a flexibly-supported joystick, wherein theflexibly-supported joystick is configured to float and the base isconfigured to remain stationary upon application of user input forces tothe first clutchless control input; a memory; and a control circuitcommunicatively coupled to the memory, wherein the memory storesinstructions executable by the control circuit to: switch the controlsystem between a first mode and a second mode; receive a plurality offirst input signals from the first clutchless control input; scale theplurality of first input signals by a first multiplier in the firstmode; and scale the plurality of first input signals by a secondmultiplier in the second mode, wherein the second multiplier isdifferent than the first multiplier, wherein the control circuit iscommunicatively coupled to a proximity detection system, and wherein thecontrol circuit is further configured to: receive a proximity signalfrom the proximity detection system; switch the control system from thefirst mode to the second mode when the proximity signal corresponds to aproximity less than a threshold value; and ignore the plurality of firstinput signals from the first clutchless control input when the proximitysignal is greater than a critical value.
 10. The control system of claim9, wherein the flexibly-supported joystick is operably coupled to amulti-axis force and torque sensor configured to detect forces andmoments applied to the flexibly-supported joystick, and wherein theplurality of first input signals correspond to output signals from themulti-axis force and torque sensor.
 11. The control system of claim 9,wherein the first mode corresponds to a gross motion mode, and whereinthe second mode corresponds to a precision motion mode.
 12. The controlsystem of claim 9, further comprising: a second control input comprisinga rotatable wrist, wherein the control circuit is further configured to:receive a plurality of second input signals from the second controlinput; scale the plurality of second input signals by a third multiplierin the first mode; and scale the plurality of second input signals by afourth multiplier in the second mode, wherein the fourth multiplier isdifferent than the third multiplier.
 13. The control system of claim 12,further comprising a rotary sensor configured to detect rotation of therotatable wrist, wherein the plurality of second input signalscorrespond to output signals from the rotary sensor.
 14. The controlsystem of claim 12, further comprising a shaft extending from theflexibly-supported joystick, wherein the rotatable wrist is configuredto rotate on the shaft.
 15. The control system of claim 14, furthercomprising: a pair of opposing actuators pivotably supported on theshaft; and a sensor configured to detect pivoting movement of the pairof opposing actuators.
 16. A control system for a surgical robot, thecontrol system comprising: a base; a first non-clutched input comprisinga floatably-supported joystick and a multi-axis force and torque sensorarrangement configured to detect user input forces and torques appliedto the floatably-supported joystick, wherein the floatably-supportedjoystick is configured to float and the base is configured to remainstationary upon application of user input forces and torques; a secondinput comprising a rotary joint and a rotary sensor configured to detectuser input motions applied to the rotary joint; a control unitconfigured to: provide a first plurality of output signals to thesurgical robot based on actuation of the first non-clutched input; andprovide a second plurality of output signals to the surgical robot basedon actuation of the second input.
 17. The control system of claim 16,wherein the floatably-supported joystick is spring-biased to an uprightposition.
 18. The control system of claim 16, wherein the control unitis communicatively coupled to a proximity detection system, and whereinthe control unit is further configured to: receive a proximity signalfrom the proximity detection system; scale the user input forces andtorques detected by the multi-axis force and torque sensor arrangementby a first factor when the proximity signal is greater than a thresholdvalue; and scale the user input forces and torques detected by themulti-axis force and torque sensor arrangement by a second factor whenthe proximity signal is equal to or less than the threshold value, andwherein the second factor is different than the first factor.
 19. Thecontrol system of claim 18, wherein the second factor is less than thefirst factor.
 20. The control system of claim 18, wherein the controlunit is further configured to ignore the user input motions applied tothe rotary joint when the proximity signal is greater than a criticalvalue.